Wufoo

Request an Appointment

Name * First Last
Please fill out.
Title
Email *

Please fill out using the format of name@domain.com
Company
Address
Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country
Phone * ### - ### - ####
Web Site
Briefly describe the business, book, product, service or cause you are interested in publicizing. *

Please fill in
What do you want to accomplish with Susan and what is your time frame for reaching your goals? *

Please fill in
How do you envision working together?
Media Coaching Creating a publicity and marketing plan Brainstorming publicity angles Get publicity-media placements Develop products, services, speeches Become a national spokesperson Become an expert commentator Get on Oprah All of the above

Please check all that apply
Please indicate your budget parameters for this project. *

Please select one
Time frame *

Please select one
How you were referred to me. *

Please fill in.
How would you prefer to be contacted? *
Email Phone

Please indicate preference
Pro Bono

NOTE: Susan's pro bono (FREE) service roster is full for the next 2 years and her waiting list is closed.
Do Not Fill This Out
Do Not Fill This Out