Workshop Facilitator Request Form

Corporate Workshop Request Form
Thank you for considering Rochelle Gapere to facilitate your Corporate Workshop!

Please complete this request form so we can learn more about your event and check Rochelle's availability.

We will review your request and get back to you via email within the next 2-3 business days.

Let's get started!
Tell Us About Yourself
Your Name*

First NameLast Name
Your Company/Organization*
Your Email Address*
example@example.com
Your Phone Number*
Please enter a valid phone number.
Tell Us About Your Event
Workshop Name*
Workshop Location*
Workshop Date*
Workshop Time*
Workshop Topic and Description*
Tell Us About Your Workshop
Budget for Speaker*
Expected Audience Size*
Audience Demographics*

C–Level ExecutivesIndustry ProfessionalsNew Hires/InternsGeneral PublicOther
What is the "Other" Audience Demographic?
Any special notes, requests, or equipment/AV requirements?
Privacy Policy*
Should be Empty:

Corporate Workshop Request Form