Organization/School/Program Name *

Primary Contact Name *

Title/Role *

Phone Number *

Email Address *

Type of Organization *

Address *

Street

City

State

Country

Postal Code

E-Athlete Experience Format (copy) *

The E-Athlete Teaser Film Screening

Public Speaking Engagement

Interactive Novel Passage Reading

Live Q&A/Youth Discussion

Recreational Activity (Adaptive Sports)

Gaming Tournament/Free Play (Video Games)

Combination (Sports + Gaming)

Would you like to pre-order bulk copies of The E-Athlete Novel for your participants?

If "Yes" please specify your order

Preferred Date(s) *

Preferred Start & End Time *

Estimated Number of Participants *

Age of Grade Level

Are any participants a part of the impaired/disabled community? *

Are there any accommodations or accessibility support we should be aware of? *

Do you have a gym, auditorium, classroom, or theater available for use? *

Do you have any audio/visual equipment? *

Do you have access to video game equipment? *

Is your organization prepared to financially book this service? *

Would you like information on sponsorships or donors covering cost?

Estimated Budget or Funding Request

How did you hear about The E-Athlete Experience? *

By checking this box, I understand that submitting this form is a request and does not confirm booking.

By checking this box, I consent to receive transactional messages related to my account, orders, services I have requested, marketing and promotional messages, appointment reminders, order confirmations, special offers, discounts, new product updates, account notifications among others. Message frequency may vary. Message & Data rates may apply. Reply HELP for help or STOP to opt-out.