Jay Barnett Booking Request Form
Contact Info
Please fill out the following information about your event and someone will get back to you within 24-48 hours.
Requestor's Full Name
*
Title
First Name
Last Name
Phone Number
*
-
Area Code
Phone Number
E-mail
*
Event Date & Expected Arrival Time
-
Month
-
Day
Year
Date
1
2
3
4
5
6
7
8
9
10
11
12
:
Hour
00
10
20
30
40
50
Minutes
AM
PM
AM/PM Option
Type of Event/Brief Description
*
Location/City
Requesting Role
*
Host
Emcee
Moderator
Keynote Speaker
Panelist
General Appearance
Other
If panelist, please provide discussion topic
Estimated Honorarium
*
Estimated # of Participants
*
Is this a ticketed event
Yes
No
Is this a nonprofit event
Yes
No
Will this event be recorded and distributed for commercial purposes?
Yes
No
Is Jay allowed to sell merchandise
Yes
No
Are you providing hair, and makeup or car service
Yes
No
Is Jay expected to do any press/media to promote the event
Yes
No
Will Jay be the only name/image used to promote the event
Yes
No
Any other national talent attached, if so who
A 50% deposit is required when booking and final payment must be received 7 days before the event.
Other Important Information?
Submit
Should be Empty: