Booking Request

Street Address

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Phone Number

MSW, LCSW, CCFC, LCAS

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Please complete the form below:

Name

First Name

Last Name

Subject

Message

How did you hear about Kim?

What topic are you asking her to speak on?

Describe your audience:

Length of time for Kim to speak:

Describe your event:

If this is a food event, will the participants be finished eating prior to her speaking?

If this is a Christian event, will there be worship music before and/or after Kim speaks?

Is a hands-free microphone available? (Kim prefers hands-free)

Will there be a production person/team at the event?

If Kim uses slides, what software does your facility use?

What is the financial compensation you are offering as a speaking fee?

What is the reimbursement for gas if more than 30 miles from Charlotte, NC?

If overnight stay is necessary, is her hotel stay compensated?

Kim Honeycutt, MSW, LCSW, CCFC, LCAS
Psychotherapist | Trauma Recovery Consultant

Text: 704-564-2647
kim@kimhoneycutt.com