CONTACT / BOOKING FORM
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 CONTACT:
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NAME: *
PHONE NUMBER:
EMAIL: *
NAME OF YOUR SCHOOL OR ORGANIZATION:
TYPE OF ORGANIZATION:
(CHOOSE ALL THAT APPLY)
IF YOU SELECTED "OTHER" ABOVE PLEASE EXPLAIN:
LOCATION OF WHERE YOU WOULD HOST A DIGITAL EMPOWERMENT EVENT:
(INCLUDE ADDRESS SO THAT THE TRAVEL FEE CAN ACCURATELY BE DETERMINED)
WHAT TYPE OF DIGITAL EMPOWERMENT EVENT ARE YOU CONSIDERING?:
(SELECT ALL THAT APPLY)
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ADDITIONAL DESCRIPTION FOR EVENT TYPE:
IF YOU ARE SCHOOL, PLEASE TELL ME ABOUT YOUR SCHOOL INCLUDING YOUR STUDENT POPULATION:
DO YOU HAVE A PREFERRED DATE FOR YOUR EVENT?:
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HOW WOULD YOU LIKE TO BE CONTACTED?:
HOW DID YOU HEAR ABOUT THE DIGITAL EMPOWERMENT PROJECT?:
ADDITIONAL COMMENT OR QUESTION:
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