Speaker Request Form Please enable JavaScript in your browser to complete this form.Thank you for your interest. Please complete the form below. A representative from Dr. Christine's team will contact you regarding availability, fees, and event details. Organization Name *Primary Contact Name *Phone *Email *Website *Event Details Event NameEvent DatesEvent LocationVenue NameExpected AttendanceType of EventConference or ConventionCorporate EventNonprofit EventEducational InstitutionFaith-Based EventFundraiserWorkshopOtherPreferred Presentation Topics Turning Trauma into Triumph How to find your voice, tell your story, reclaim your power, and make a difference after devastating experiences. The Power of Kindness in a Cruel World Stop judging and start helping. How empathy, dignity, and kindness can transform individuals, organizations, and communities. Understanding Coercion, Cults, and High-Control Groups How manipulation works, why people comply, and how outsiders, agencies, and law enforcement can better understand and help survivors. Human Trafficking: Myths and Realities Can belief systems be a tool of human trafficking? How understanding lesser-known facts can help people advocate for themselves and others. Media, Healing, and Survivor Dignity How media, public opinion, and online narratives can either harm or heal survivors, by Dr. Christine and Nomz, from Trust Me - The False Prophet. Write the name of your preferred presentation above, or something else if it is not on this list.Is there a special angle you would like Dr. Christine to focus on?Will the audience primarily include survivors of trauma, human trafficking, sexual abuse, coercive control, domestic violence, or cult involvement?YesNoPossiblyPresentation Format Requested FormatKeynote AddressWorkshop or Training ProgramBreakout SessionPanel DiscussionQ & AVirtual PresentationOtherRequested Presentation Length30 inutes45 minutes60 minutes90 minutesHalf day workshopFull day workshopOther or flexibleAudience InformationPlease describe the audienceWhat are the primary goals of this event?Event Logistics Will audio and visual equipment be provided?YesNoPossiblyWill the presentation be recorded?YesNoPossiblyWill the presentation be livestreamed?YesNoPossiblyWill media interviews be requested?YesNoPossiblyPlease provide details about recording, livestreaming, media interviews, or other production needs.Travel Requirements Dr. Christine lives in Colorado City, AZ. Will air travel be required?YesNoUnsureWill you be making the travel arrangements?YesNoNo, but we will cover the travel costs.Nearest airportWill ground transportation be provided?YesNoTo be discussedBudget Information Speaker Budget RangeUnder $1,000$1,000 - $2,500$2,500 - $5,000$5,000 - $10,000$10,000 - $20,000Over $20,000Please share any additional information that would help us evaluate your request.Agreement By submitting this form, you understand that completing a booking request does not guarantee speaker availability. All engagements are subject to scheduling, contract approval, and mutually agreed-upon terms. Agreement ConfirmationI have read and understand the statement above.Name of Person Submitting Request *Title or Position *DateNotes Comment or MessageCommentSend Request
