Thanks for Booking Juanita for Your Next Event

We are So Appreciative for your Organization Choosing Us

Point of Contact Name *

First Name

Last Name *

Your Title or Position

Best Contact Number *

Your Email *

Can We Text You at This Number? *

Name of Your Amazing Organization *

Type of Organization *

Organization Website *

Event Start Date *

Start Time

Enter the Time

Event End Date *

End Time

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Event Name *

Planned Number of Attendees *

Purpose or Theme of the Event *

What Challenges or Concerns is Your Organization Facing (if any) and What Outcome Would You Like to Achieve When The Event Ends? *

Venue Name *

Address

Street Address

City

State

Country

Postal Code

Closest Airport to Event *

Is This Event Open to The Public? *

Will This Event Be Recorded or Live Streamed? *

Will You Have a Videographer at the Event?

If you have a videographer, how many do you have filming the event?

If a Videographer is Provided, Please List Contact Information *

How Much Time Will Juanita Have to Speak? *

What Topic Would You Like Juanita to Speak About? What Outcome Do You Want for The Audience?

Estimated Budget for Speaker *

Estimated Budget for Merchandise (Hoodies/T-shirts etc..) *

Estimated Budget for Professional Development (Workbooks|Online Programs | WorkShops Live or Virtual) etc.. *