THANK YOU
By completing this form you are helping Juanita increase the value that she brings to the event. If you would prefer to answer these questions over the phone, give us a call on 404-955-9740. Thanks in advance for your time.
Name of your Organization
Your Website Address
Event Date
-
Month
-
Day
Year
Date
Would you like for Juanita to attend an event the night before?
Yes
No
Provide the name and number of Juanita's primary contact.
What is your organization's largest challenge right now?
Who are your primary customers? Who do you serve?
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Help Juanita Better Prepare for this Event
Are there any topics that Juanita should avoid? Please explain.
Would you like Juanita to contact an audience member who can speak to the daily challenges or successes of this organization? If so, email us names and numbers at least 2 weeks prior to the event.
Is there anything else Juanita should know about the people in attendance?
Any phrases, acronyms, or words Juanita should mention during her presentation?
What is the overall theme or focus of this event?
What events precede Juanita's presentation?
Will there be a translator on or near the stage as well?
Yes
No
If you know the name of the ballroom where Juanita will be speaking, please enter it here.
What time would you like Juanita to arrive on the day of the event?
Hour Minutes
AM
PM
AM/PM Option
Will Juanita be allowed to video and/or audio record her presentation?
Yes
No
Let me check and see
Please feel free to share any other information or details that you feel Juanita should know before her arrival.
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Your Contact Information
Name
First Name
Last Name
Email
example@example.com
Phone Number
Please enter a valid phone number.
Signature
Submit
Submit
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