Speaking Engagement/Workshop Questionnaire for Justin Black
Thank you for your interest in considering having Justin Black for your next event. Please fill in the questionnaire below in as much detail as possible. Our goal is to provide you with the best possible experience. This form will help us to best meet your needs and tailor the presentation specifically for your group or organization.

If you have any questions, please email roseempowermentgroup@gmail.com or call (248) 289-0844
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Email *
Name *
Name of Organization *
Name and Location of venue for event *
What date are you requesting? *
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Event Title and Description *
Type of Event or Conference *
What are your objectives for the speaker? *
Sensitive Issues to Avoid during presentation? *
Will attendees be eating during Justin's presentation? *
Number of Expected attendees *
Main reason for bringing in a speaker *
What is your budget for speaker honorarium? *
How many minutes would you like for Justin to present? *
Additional notes
A copy of your responses will be emailed to the address you provided.
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