Service Request Form
AnaYelsi Velasco-Sanchez
Email address *
Name *
Your answer
Name of Organization (If Applicable)
Your answer
Phone Number
Your answer
What service are you seeking *
Required
Please answer the following questions to the best of your ability. If a question is not applicable to a service you're seeking, write N/A in the response area.
For trainings and speaking engagements: What are the dates and times of your event (s)?
Your answer
For trainings and speaking engagements: Who is the audience for this event? How many people are you expecting? Please describe your target audience -age, faith/religion, gender/sexuality, race/ethnicity, socioeconomic background, etc.
Your answer
For trainings and speaking engagements: What theme(s) would you like me to teach/speak on? What have you already done to prepare your participants toward these themes?
Your answer
For trainings: How many training sessions are you seeking? How long would you like each session to be?
Your answer
For 1-1 coaching, consulting, and facilitation services: What are you seeking these services for? How many sessions are you seeking?
Your answer
Are you able to cover honorariums/fees associated with the service (s) you are seeking? *
In addition to the honorarium/fee, are you be able to cover travel - standard coach rates out of Reagan National airport (preferably American Airlines)? Lodging in a single-occupancy hotel room? A $60 meal per diem (includes event days and travel days)?
Your answer
All services include a $50/day late fee for payments not received by the date agreed to in service contract.
What date do you need a decision by about working with AnaYelsi
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