Booking

Please answer every question on this form. Thank you in advance!

FULL NAME:

ORGANIZATION:

ADDRESS:

CITY:

STATE:

ZIPCODE:

PHONE:

EMAIL ADDRESS:

WEBSITE:

TYPE OF GROUP:


SELECT SERVICE REQUESTED:
 Speaker Keynote and Motivational Performance Consulting Guest Appearance Healthy Food, Nurtition, and Lifestyle Workshop Writing Your Story Literary Master Workshop Improvasation Class HIV Prevention Master Workshop Breast Health Master Workshop Free Jazz Band Customized Topic

SELECT SHOW REQUESTED:
 Don't Wait Until It's Too Late Fooling Yourself Into Fun Foods and Fitness Wake Up To Stay Alive First Food Desert Bucking The Bull Trails, Not Tribulations Boomerang The Men In Me Mama Juggs Commissioned Original Work

LENGTH OF SERVICE:
 10-15 Minutes 30 Minutes 45 Minutes One Hour 1.5 Hours 2 Hours 2+Hours

BUDGET ALLOCATED FOR OUR SERVICES: (Please note: This amount does not include Transportaiton, Lodging, Meals or Incidentials):
At this time, we are not accepting any offers for free/volunteer opportunities.
 Budget $ (Do Not Leave Blank)

DATE(s):

TIME:

LOCATION OF ENGAGEMENT (Full Address or City & State, if TBD):
DESCRIPTION OF YOUR EVENT: