Nutrition, Health & Wellness Event Request Form

Nutrition, Health & Wellness Request

Thank you for contacting The Maxine Firm! We are looking forward to sharing with your organization! Please complete the form below .
Name*

PrefixFirst NameLast Name
Organization's Name *
Organization's Website *
Event Name *
Event Location Address *
Phone Number

Area CodePhone Number
E-mail*
example@example.com ( The invoice will be sent to this email)
Audience Demographic*

YouthAdultsAll AgesWomen OnlyMen Only
Projected Attendance*

1-3060- 9030-60100 & Above
Desired Length of Presentation?

15 Minutes30 Minutes60 MinutesOther
Approximate Date / Time*

MonthDayYear
DateHourMinutesAM/PM Option
Event Location

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Will the event space have access to the internet & a projectors?
Will the event be broadcasted on a virtual platform.
Select all presentation topics and or sessions you would like included in your event. Once your selections have been submitted, a detailed invoice will be email to your event organizer.

Principles of Balanced Nutrition & Weight ManagementMeditation & YogaHealthy Food DemonstrationsHold Up Hypertension & Heart Attack SessionJuicing DemonstrationStrategies for coping with Anxiety & DepressionLow Impact Group Fitness Session21st Center Urban Gardening SessionNavigating Nutrition & Mental Health SessionDiscussion Panel LuncheonNutrition for WomenPreventing & Managing Diabetes SessionOther
Budget *
Please provide any topic or special requests.
Should be Empty:

Nutrition, Health & Wellness Request