MOVIE SCREENING AND MOTIVATIONAL SPEAKING ENGAGEMENT REQUEST FORM
AVAILIABLE: VIRTUAL OR IN-PERSON
Name
First Name
Last Name
Phone Number
-
Area Code
Phone Number
Email
example@example.com
Select what type of service(s) you are interested in booking?
Chess/Character Building Program
Motivational Speaking Engagement
Both
Type of organization or institution you are inquiring for (i.e. non-for profit, educational, religious, etc?
Proposed date of event and length of time needed?
Wanted as keynote speaker, motivational speaker, or panel member?
Estimated size of audience?
Estimated age range of audience?
Will there be a Q &A?
What type of audience will we be serving? ( Youth, Adults, Returning Citizens?)
Is there a topic other then "Self-Empowerment" you are interested in having the speaker appear for?
Approximate budget for apperance?
Submit
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