Book Harambee Wellness for your event

Corporate Wellness Questionnaire
Thank you for your interest in bringing the Harambee Wellness experience to your organization. To assist us in understanding your program needs, please complete the following information.

Let's Thrive Together

#ThriveWithHarambee
Form Name
Form Submission Date

Month Day Year
Date
What is your name? *

First Name Last Name
What email address shall we send the response to? *

Confirmation Email example@example.com
What is a good phone number to reach you? *
Please enter a valid phone number.
What is your preferred method of communication? *

Phone Call Email Text Message No Preference
What's the name of the Business/Organization/Person hosting this event? *
About Your Event
Which service(s) are you interested in? *

Fitness Instruction Cooking Demo Workshop Corporate Wellness Consulting
Select a Fitness Format

Cardio Blast Boot Camp Tabata Strength & Stretch Zumba Customized Format
Select a Recipe Theme

Budget Friendly Meals Cooking 101: Survival Basics Cooking for the Week Kids in the Kitchen Healthy Snacks Leftover Remix One-Pot Meals Pantry to Plate Simply Salads Quick, Healthy Meals
Select a Workshop Topic

Nutrition & Active Living Restoring Your Energy Self-care at Home Power of Positive Thinking Time Management Other
What are the desired outcomes for the program? (This helps with the program's content customization to meet your event focus and objectives)* *
You can upload additional details here (optional)

Maximum of 2 files can be uploaded
Cancel of
Who is the target audience for the program *
How many participants do you expect to attend? *
It's okay to estimate.
What is the proposed date and start time? Please note: Harambee Wellness operates within the Eastern Time Zone Detroit, MI (GMT-5) *

Month Day Year
Date
Time AM/PM Option
Desired duration of requested service(s) *
Is this request for a recurring program? *

Yes No
Number of sessions for the program?
What is your budget range for the event workshop/instruction/presentation? *
Please enter a numeric value
Will your program be open to the public or is it a private event where only members/people in your network are able to attend. *

Completely private event (for a certain group of people i.e friends, workgroup or members only) Semi- Private (I have a set group of people but, would like to publicly invite more) Open to the public Other - Please specify
Where will the program be held? *

In-person Virtual To be determined
Location of the program

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code
Where will program be held? *

Indoors Outside
Will program be live streamed via Social Media or other platforms?* *
Ex: Streamed to Facebook page via Zoom
Do you need Harambee Wellness to provide digital streaming service, i.e. Zoom, StreamYard, etc? *

Yes No Not Applicable
Please verify that you are human :-D *
Should be Empty:

Corporate Wellness Questionnaire