BOOKING FORM

Dr. Dominique will engage, educate and empower your audience through thought-provoking stories and actionable steps. Your audience will thank you for booking her. Please complete this booking form and a member of the team will be in touch within 24-72 business hours!

NEW CLIENTS START HERE

ACCEPTING NEW CLIENTS >> SELF-PAY ONLY

BOOKING FORM

Please complete this booking form and a member of the team will be in touch within 24-72 business hours!

Time of Event

Age Group for Attendees

18 and older

High School

Middle School

If applicable, upload supporting documents.

If applicable, upload supporting documents.

THANK YOU FOR SUBMITTING. PLEASE ALLOW 24-72 BUSINESS HOURS FOR A RESPONSE.