Book Dr. PJ for Your Event

First Name*

Last Name*

Email*

Company/Organization Name*

Phone*

Type of Organization*

Event Name*

Event Date and Time*

What is the exact time for Dr. PJ's anticipated arrival?*

Event Format*

Event Location/Address*

Expected Number of Attendees*

What are the primary characteristics of the expected/targeted audience?*

Type of Event*

Conference, Workshop, Brunch, etc.

Will Media Be There? If so, please provide Media list.*

Cost of Attendance (provide member & non-member price, if applicable)*

What is your speaker budget? (include exact cost and/or range)

In what capacity would you like Dr. PJ to participate?*

Keynote Speaker

Workshop Facilitator

Trainer

Panelist

Moderator/Interviewer/Host

Appearance

Other

How long would you like Dr. PJ to speak?*

Desired Topic*

Please indicate what will be available for the speaking request.*

Podium

Microphone

Projector & Screen

Table

Chair/Stool

Other

Will Dr. PJ be allowed to promote her books and/or services?*

Will travel arrangements be necessary? Dr. PJ is based out of Houston, TX*

Deadline for Acceptance*

Provide a link to the event page and/or any promotional site

Any additional information you'd like to share?*

DEBORAH DAVIS

We Mean Business Chairperson

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