Speaker Request Form

Questions? Call +1-713-569-5294*
Name of contact person*
Mailing Address*
Meeting Specifics*
Honorarium (please write a specific U.S. dollar amount)*
Overnight Accomodations*
Hotel Address*
Logistics
Expenses (Meetings less than 200 miles)
Expenses (Meetings more than 200 miles)
Expenses Name of person completing this form
Address

NOTE: After we have sent you a letter confirming all arrangements, a cancellation fee of 25% of the honorarium will be assessed on the party who cancels the engagement. The canceling party will also be responsible for any non-refundable airfare/travel costs or misc. expenses.

About

Dr. Cynthia J. Hickman, is Your Proactive Caregiver Advocate. I am an Author, Educator, Speaker, Consultant. As a registered nurse by profession, one would think caring for a loved one in the home would be simple. One would think my expertise as a nurse well-equipped me. Yes, my nursing career provided guidance, but 24/7 care in the home uncovered more than staying on top of activities of daily living(ADL).

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Contact

Call Us

713-569-5294

Email Address

drcynthiaj@cynthiajhickman.info

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