BOOKINGS
Request Form
Hey! Thanks for showing interest.
This is a form for making the booking process easier and faster
Your name
*
First Name
Last Name
E-mail
*
When is your event?
*
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Month
-
Day
Year
Date
Company
*
Company Website
*
Phone
*
Service requested?
*
Please Select
45-60min Keynote
90min Leadership Development Training
Brief description of your event
*
Please don't hesitate on giving as much info as you want, is better for me to understand your vision!
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Name of venue?
*
Venue Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
What are details the purpose of the event?
*
If want to know something else that is not in the form
What are the main pain points of the audience?
*
What do you want them to walk away with?
*
Estimated number of people to attend?
*
Demographic of attendees?
*
Will this event be open to the public?
*
Yes
No
Will tickets be sold? - Ticket sales must be approved by JCCD
*
Yes
No
Do you intend to record, or live stream?
*
Yes
No
Can products be sold at the event?
*
Yes
No
Speaking Budget?
*
Must enter a dollar amount
Please verify that you are human
*
Submit
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