PRE-EVENT QUESTIONNAIRE
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Email *
Company/Association:
(Please provide information about company)
Company/Event​ ​Website:
Contact’s​ ​Name​ ​&​ ​Title:
Contact’s​ ​Email:
What​ ​is​ ​your​ ​role​ ​with​ ​planning​ ​the​ ​event:
Contact’s​ ​Address/City/State/Zip:
Contact’s​ ​Phone:
Event​ ​Location​ ​–​ ​(City​ ​|​ ​State​ ​|​ ​Venue):
Purpose​ ​of​ ​meeting/event:
*
What​ ​service would​ ​you​ ​like​ ​Nubia Henderson​ ​to perform​ ​(i.e.​ ​keynote,​ ​conference​ ​workshop,​ ​private​ ​seminar)?​ 

​Is there​ ​more​ ​than​ ​one​ ​appearance​ ​requested?​ ​
What topic (s)​ ​would​ ​you​ ​like​ ​Nubia Henderson ​to​ ​present?
*
Required
What​ ​is​ ​the​ ​Date​ ​of​ ​the​ ​Event? What day (s) would Nubia Henderson present? *
MM
/
DD
/
YYYY
What time would Nubia Henderson present? *
Time
:
How​ ​long​ ​would​ ​the​ ​presentation​ ​last?
*
Required
Demographic​ ​and​ ​Profile​ ​of​ ​Group(s)​ ​to​ ​be
spoken​ ​to (ie, gender, age, martial status, specific need being addressed):

*
How​ ​many​ ​people​ ​will​ ​attend?
*
Required
What is your budget? *
Required

Is​ ​travel/lodging​ ​included​ ​for​ ​the​ ​speaker
PLUS​ ​one​ ​assistant?​ ​
*
What​ ​is​ ​the​ ​closest​ ​airport?​ ​
Will ground​ ​transportation​ ​and​ ​meals​ ​be​ ​provided?
(Nubia Lives Yoga travels from Chicago)
*
Additional​ ​Comments:
A copy of your responses will be emailed to the address you provided.
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