Jeanette's Speaking Request Form
Thank you for your inquiry! If you would like to extend an invitation to have Jeanette speak at your upcoming event, please use this form to submit your request. Upon receipt of your request, we will contact you within (48) business hours. Please note that this form does not guarantee the engagement, but begins the process of checking date availability, budgetary requirements, and presentation needs. We appreciate your interest, and we're honored that you would consider Jeanette as a speaker for your event.
Contact's First Name:
Contact's Last Name: Street Address: City: State: Zip Code: Phone Number: Alt./Cell Phone: Email Address: Event Date: Alt. Event Date: Event Location (Venue): Event City: Event State: Approximate Audience Size: Audience Profile: Men Women Youth Professional Audience Description: Age Range of Audience: Your Budget for this Engagement: Is this an annual event? Yes No
If no, how many years has this event been in existence? Are there other speakers? Yes No If Yes, who are the other speakers? What media will be covering the event? Will this event be videotaped? Yes No
Will this event be audio recorded? Yes No What are you requesting Jeanette to do? (Keynote, Facilitator, Presenter, Panel, etc.) How long would you like Jeanette to speak?
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