Thank you for nominating your colleague or yourself to be a panelist on Love Medicine TV. Please answer all questions on behalf of the person seeking to be a guest. We will be in touch with you regarding the approval of guest spot shortly.

Wellness wishes,

Sacred Walker
CEO
Kuumba Health LLC
Love Medicine TV
www.khhp.org
www.facebook.com/lovemedicinetv

Question Title

* 1. What is your first name?

Question Title

* 2. What is your last name?

Question Title

* 3. What is the name of the person you are nominating?
(Please answer the remaining questions on behalf of yourself or the person you are nominating)

Question Title

* 4. In one sentence, please summarize your passion or what drives your ethical compass?

Question Title

* 5. Do you have prior experience speaking on a panel and/or offering a training in front of an audience?

Question Title

* 6. What is your industry and/or area of focus? (check all that apply)

Question Title

* 7. What is the highest level of education you have completed?

Question Title

* 8. What spiritual practices or faith tradition(s) do you most identify?

Question Title

* 9. What is your favorite kind of warm beverage?

Question Title

* 10. What is your phone number?

Question Title

* 11. What is your e mail address?

Question Title

* 12. Which of the following hot topics interest you? (check all that apply)

Question Title

* 13. List one of your other favorite hot topic? (optional)

Question Title

* 14. What area(s) in Kuumba Health's soulcare mission does your work most align?

Question Title

* 15. What product, service, and/or up-incoming event would you like to promote at the closing of our Love Medicine Virtual TV Broadcast (Hosted by Sacred Walker, CEO Kuumba Health)?

Question Title

* 16. What is your website, Linked-in, Facebook, Twitter, Youtube channel, Instagram... (include at-least 1 or more)

Question Title

* 17. Do you respect diversity including others perspectives who identify as LGBTQ, African-descent, and Women etc.?

Question Title

* 18. About how many years have you been in your current position?

Question Title

* 19. Thank you for your valuable time. It is an honor to host you & I look forward to our Love Medicine tea time- talk! Please submit your debut request date within 48 hours of this submission at

www.meetme.so/buildingkuumbahealthbridges

Once approved, your date will be confirmed. Please write your initials below to confirm that you give consent to being considered as a Broadcast guest.

T