Booking - Anita WoodleyAnita Woodley

Name of Organization?
Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Your Full Name
First Last
Best Contact Number
Email
Date & Time requested for service
Other
Length of service
- 90 minutes
- 60 minutes
- 30 minutes
- 20 minutes
- 15 minutes
- 10 minutes
- To be determined
- Other
Select Service Requested
- Consulting
- Performance
- Powerpoint Presentation
- Guest Appearance
- Keynote Address or Closing Plenary Presentation
- Commencement Speaker
- Motivational/Inspirational Speaker
- Customized Topic Tailored to Our Event
- Comedy
Select Performance Requested
- Mama Juggs Show: Breast Health/Cancer Awareness/Prevention, Self-Esteem, and Body Image
- Don’t Wait Until It’s Too Late Show: Real Breast Cancer Experience with Documentary
- The Men In Me Show: Urban Male Issues HIV/AIDS, Domestic Violence, Recidivism, Sex Trafficking, Marriage & Police Brutality
- Bucking the Bull: Black Male Experiences with the Medical & Health Care System in America
- Boomerang Show: Sharpening Awareness about Racism & Sexism in the Workplace
- First Food Desert: Breastfeeding Education
- Trials, Not Tribulations Show: Encouraging Clinical Trial Participation by African-Americans & Choosing the Clinical Trial that Best Fits You
- Wake Up to Stay Alive: Understanding Health Disparities in Black Males
- Fooling Yourself Into Fun Foods & Fitness Show: Simple Ways To Live A Healthier Life
- Health & Nutrition Show: Great-Grandma’s Healthy Kitchen Educational Demo
- Remodeling the Brick House Show: A Successful Journey to Reverse Pre-Diabetes & Obesity
- Other: Commissioned Original Work
Select Workshop/Residency Requested
- Educational Health Presentation
- HIV/AIDS Prevention Workshop
- Forgiveness & Self-Empowerment Workshop
- Flipping the Script on Self-Esteem: Creating Your Own Powerful Future with Practical Life & Social Skills through Improv Workshop
- Standup Sketch Comedy on a specific topic
- Personal Narrative & Literary Skills Development Residency
- Inner-Work & Self-Compassion Workshop
- How to Lose Weight & Gain Your Life Back after a Health Scare
- African & African-American Geniuses in Current Living & Past History
- African Face Painting with Adinkra Symbols
- Other
Amount budgeted for the requested service?
Name of venue location?
Full Address of the venue/location?
Is this a conference? If yes, what are the official start & end dates?
Anticipated/Estimated Attendance?
Type of Group
Method of Payment?
- Cashier’s check, Company check, or money order guaranteed form of payment
- Credit Card (We accept all major credit cards. *add 3.00% service charge to fee)
- Electronic Funds Transfer (Add $15 service fee per EFT transmission)
Does your organization provide roundtrip transportation and lodging?
If not, an all-inclusive quote will be prepared
Person who approves and authorizes contract agreements?
Name
First Last
Email
Phone
Contact person for payment?
Name
First Last
Email
Phone
Description of the event & additional information:
(Please note: This amount does not include Transportation, Lodging, Meals or Incidentals):
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