Blk Women Wellness Event & Wellness Experience Inquiry
Please complete this form to request a wellness experience with BLK Women Wellness Co. All required fields must be filled out for your inquiry to be processed.
Contact & Organization Details
Full Name
*
Email Address
*
example@example.com
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Organization / School / Company Name
*
Organization Type
*
Please Select
Corporate / Workplace
K–12 School
College or University
Community Organization / Nonprofit
Other
Your Role / Title at the Organization
*
Event Details
Event Name or Description
*
Preferred Event Date
*
-
Month
-
Day
Year
Date
Alternative Date
-
Month
-
Day
Year
Date
Event Start Time
*
Hour Minutes
AM
PM
AM/PM Option
Event Location / Address
*
Is the venue accessible (elevator, ramp, accessible restrooms)?
*
Yes
No
Unsure
Wellness Experience
Which experience are you requesting?
*
Yoga
Guided Meditation
Love Letter to Self Activation
Bloom Bar
I'm open to a recommendation
If yoga is selected, Would you need yoga mats provided?
Yes, please include yoga mats (+add-on fee)
No, attendees will bring their own
Some attendees may need mats
Expected Number of Attendees
*
Audience Description
Accessibility & Special Needs
Do any attendees have physical limitations or mobility considerations we should know about?
*
Yes
No
If yes, please describe
Any additional accommodations or accessibility needs?
Budget & Logistics
What is your budget?
$500 - $750
$800 - $1000
$1500 - $2500
How did you hear about BLK Women Wellness Co.?
Please Select
Instagram
Word of mouth / referral
A past event
Google / web search
Other
Anything else you'd like us to know?
Submit Inquiry
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