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KB
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rew
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BOOKING
MENTORSHIP
Kim Burrell
Request Form
For all booking request, please fill out and submit this form. The Request and Mentorship fee is based on the request details. All request will be responded to via email.
Title (Mr. - Dr. - Rev. etc.)
First & Last Name
Type of Request (30 secs to 1 min)
Choose an option
Other (please explain)
Request Details
Who is the request for?
Choose an option
To (Name) & From (Name) *If for someone else*
Request Deadline (Type Date)
If Mentorship *Hourly Session via Zoom* (please select)
Choose an option
Other (please explain)
Phone Number
Email
Additional Information
Please note that completion and submission of this form does not and will not guarantee availability.
Submit
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