Book Jan Today!
We are humbled that you have considered booking Jan Mitchell for your upcoming event! Please fill out this enclosed form in its entirety, and you will be contacted soon. Thanks again for your consideration.
Name
First Name
Last Name
E-mail
Phone Number
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Area Code
Phone Number
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Company Name / Organizational Affiliation
Is Your Event Online or In-Person?
Please Specify The Start Time And Duration Of Your Event. What Is The Amount Of Time Allocated For Jan To Speak? Ex: 30 minutes, 45 minutes,etc.
(Please note that Coach Jan is not available to accept any speaking opportunity under 30 mins. Thank you for your consideration.)
Time
1
2
3
4
5
6
7
8
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10
11
12
:
Hour
00
10
20
30
40
50
Minutes
AM
PM
AM/PM Option
Suggested dates for your event
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Month
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Day
Year
Date
Are these dates flexible?
Will you charge a fee to attend your event ?
Amount of the Honorarium For This Event?
(Please note that Jan has a min.requirement which will be discussed during call)
How many are expected to attend your event?
Event topic?
Signature
Submit Form
Submit Form
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