DEP BOOKING INFO REQUEST
Thank you for your interest in bringing the Digital Empowerment Project to your school, church or organization. I would love to provide you with a personalize proposal on how best you can book the Digital Empowerment Project and the associated costs. Please take a few seconds to complete this interest form and after submission I will email you with information on the speaker fee and other related details. If you would me to reach out to you via the phone, just check the appropriate box below. Otherwise, I will use your email and send you an absolutely NO OBLIGATION quote within 24 hours of your submission. I am excited at the opportunity to provide you with more information. Thank you again for your interest. If you simply want me to pick up the phone and call you (smile), just fill in your name, email and phone number and I will do just that!
TYPE OF ORGANIZATION:
PLACE OF WORSHIP.
CIVIC OR PARENT GROUP.
ASSOCIATION OR ORGANIZATIONAL CONFERENCE.
IF YOU SELECTED "OTHER" ABOVE PLEASE EXPLAIN:
NAME OF THE ORGANIZATION YOU REPRESENT:
LOCATION OF WHERE YOU WOULD HOST A DIGITAL EMPOWERMENT EVENT (include address so that the travel fee can be accurately determined):
WHAT TYPE OF DIGITAL EMPOWERMENT EVENT ARE YOU CONSIDERING (select all that apply)?:
A FULL DAY OF EMPOWERMENT (YIPEE!)
DIGITAL EMPOWERMENT FOR PARENTS (2-HOUR)
DIGITAL EMPOWERMENT FOR EDUCATORS OR COUNSELORS (2-HOUR)
DIGITAL EMPOWERMENT FOR TEENS (6th through 12th grade)
DIGITAL EMPOWERMENT SPLIT SESSION (ONE HOUR TEENS/PARENTS THEN ONE HOUR PARENTS ONLY)
CONFERENCE BREAK-OUT SESSION (PROVIDE DETAILS IN COMMENT SECTION)
CONFERENCE KEYNOTE ADDRESS (PROVIDE DETAILS IN COMMENT SECTION)
PREFERRED EVENT TYPE IS NOT LISTED ABOVE.
IF YOU INDICATED THAT YOUR PREFERRED EVENT IS NOT LISTED, PLEASE DESCRIBE YOUR EVENT:
IF YOU ARE REPRESENTING A SCHOOL, PLEASE TELL ME ABOUT YOUR SCHOOL!:
DO YOU HAVE A PREFERRED BOOKING DATE FOR YOUR EVENT?:
YOUR PHONE NUMBER:
COMMENTS, QUESTIONS OR ANY OTHER INFORMATION YOU WOULD LIKE ME TO KNOW:
WOULD YOU LIKE TO BE CONTACTED BY PHONE?:
NO THANK YOU - PLEASE JUST SEND ME A PROPOSAL VIA EMAIL (NO OBLIGATION).
HOW DID YOU HEAR ABOUT THE DIGITAL EMPOWERMENT PROJECT?:
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