To Book Tina Marie or to receive more information, fill out the form below and our staff will be in touch with you shortly.
 
First Name
Last Name
Title
Organization
Street Address
Address Cont.
City
State
Zip
Country
Email
Home Phone
Have you ever done an event before?
How many people do you expect?
1st Choice of Date
2nd Choice of Date
3rd Choice of Date
What is the nature of the event?
What are the major issues your teens are currently facing?
(If this is a school or youth event)  Have any of your counselors recently dealt with any issues of abuse, sexual misconduct, deaths in family or suicides of a student?
Has there been major media coverage in the past few weeks on any of the key topics I discuss?  (abstinence, sex, drugs, alcohol, violence, suicide, cutting, bullying, blogging, pornography, etc.)
How long would you like each presentation to run?  (normal length is 90 min. – I am flexible on the time)
What is your budget for the event?
Additional Comments:
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