SPEAKER BOOKING FORM
Thank you for your interest in booking Shamyra, also known as Sexologist Shamyra. Please complete this form in its entirety. Shamyra will contact you within 48 hours to discuss your booking request. Shamyra Howard, LCSW is a Sexologist, Licensed Clinical Social Worker, International Speaker, and Founder of "On The Green Couch" where she specializes in helping people manage sexual issues, have amazing sex, and create their best relationships. Shamyra works with persons who are LGBT+, single, and those who are partnered. She loves working with the sexually diverse; including those who practice BDSM/Kink, non-monogamy, swingers, those who are poly, and those who live other non-conforming lifestyles. Shamyra has been featured on many platforms including Cosmopolitan, Huff-post, Therapy For Black Girls Podcast, Shape, and more. Shamyra is seen and heard across the world doing live trainings, seminars, and keynotes on various topics related to Sex and Relationships!
Your Full Name:
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Prefix
First Name
Last Name
Your Email Address:
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Company/Organization Name
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Your Contact Number
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Name of Event
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Date of Event
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Address of Location
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Time of Event
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Ex: (1pm or 8am)
Type of Event
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Ex: (1pm or 8am)
Expected # of Attendees
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What is Your Speaker Budget?
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How Would You Like Shamyra to Contribute to Your Event?
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Keynote Speaker
Workshop Facilitator
Trainer
Panelist
How Long Will You Need Shamyra to Speak?
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Will Shamyra be Able to Promote Any of Her Products/Services?
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Yes
No
Let's Talk About it!
Will Travel Accommodations be Needed? Please Keep in Mind that Shamyra is Located in Baton Rouge, Louisiana.
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Yes
No
N/A
Is there any additional information you would like Shamyra to know or Consider?:
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