Event Request Form
Movement & Mind-Body Sessions | Stress, Burnout & Nervous System Support | Team Culture Building Experiences | Specialized Wellness Programming | Wellness Workshop/Facilitation
Name
*
First Name
Last Name
Your Organization
E-mail
*
Phone Number
*
-
Area Code
Phone Number
Event Location
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Organization Type?
For profit
Non-profit
Other
Your Organization's Website?
Event Type?
*
90-minutes
3-4 hours
Full Day Event
Multi-Day Event
Other
Event Venue/ Online or In-Person?
Virtual
In-person
Hybrid
Other
What service are you requesting?
Movement & Mind-Body Sessions
Stress, Burnout & Nervous System Support
Team Culture Building Experiences
Specialized Wellness Programming
Wellness Workshop/Facilitation
Other
Event Description?
Event Duration/ ex: 60 minutes, 90 minutes, multiple sessions?
Suggested dates for your event
What is your budget for speaking services?
*
$2,000 - $5,000
$6,000 - $10,000
$10,000+
Other
Are these dates flexible?
Yes
No
Other
Will you charge a fee to attend your event ?
How many are expected to attend your event?
How did you hear about us?
Website
Referral
Word of Mouth
Social Media
Other
Is there any additional information you would like us to know?
Submit Form
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