Speaking and Training Request

Thank you for your interest in my speaking and training services. Please complete the information below so I can serve you better. Thank You

~Nerissa

First Name

Last Name

Email *

Phone *

Organization

State

City

Are you the decision-maker for this event/project?

Yes

No

Type of event?

What is the date of your event?

Please provide the venue location and a brief description of the venue.

Anticipated # of attendees? (Numbers only)

What speaking/training topic are you requesting?

Do you have a budget allotted for this project?

Yes

No

How did you hear about us?

Walk In/Friend

Google

Facebook

Other

Is there anything else that I should know to make your project successful?

I agree to terms & conditions provided by the company. By providing my phone number, I agree to receive text messages from the business.