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Event or Media Inquiry
This is an interest form to book Angela Banks and associates of "The Clarity Couch" for events or media appearances
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* Indicates required question
Name
*
Your answer
Company/Organization
*
Your answer
Company Address
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Your answer
Email Address
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Your answer
Name and Description of Event
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Your answer
Virtual or In-Person Event
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Virtual
In Person
Optional
Tentative Date and Time of Event
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MM
/
DD
/
YYYY
Time
:
AM
PM
Is the date and time flexible?
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Your answer
Expected length of interview, talk or presentation?
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Your answer
Number of Event Attendees
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Your answer
Demographics of audience
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Your answer
Is there a cost to attend the event?
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Yes
No
What is the budget for speakers and presenters?
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Your answer
Will this event be recorded?
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Yes
No
What else should we know?
*
Your answer
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