4-Minute Information Form
Please complete the four-minute information form so that we may adequately assess your request. Your request is important to us and we will return a response shortly.
First and Last Name *
Your answer
Organization Name (if applicable)
Your answer
Phone number *
Your answer
Email *
Your answer
What services are you inquiring about? *
What is the anticipated date of your event?
MM
/
DD
/
YYYY
What is the anticipated time of the event?
Time
:
What city and state will the event take place? *
Your answer
What is the theme of your event?
Your answer
Please specify the type of audience your event is geared towards (i.e. youth, minorities, parents, etc.)
Your answer
What is your budget for this event?
What have you budgeted for an honorarium for Bert or donation for Speaks 4 You, Inc. for this event? *
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