JavaScript isn't enabled in your browser, so this file can't be opened. Enable and reload.
Questionnaire Form for Embrace Her Legacy (Maria I. Melendez, Embrace Her Legacy Founder)
Please fill out this form with as much detail as possible for a quote and confirmed availability for request. Thank you!
Sign in to Google
to save your progress.
Learn more
* Indicates required question
Contact Name:
*
Your answer
Contact Email:
*
Your answer
Contact Phone Number:
*
Your answer
Name of Organization or Event:
*
Your answer
Date of Event:
*
MM
/
DD
/
YYYY
Time of Event:
*
Time
:
AM
PM
Is this event virtual or in-person?
*
Virtual
In-Person
Other:
If this is a virtual event, will it be live or pre-recorded?
Live
Pre-recorded
Combination of both
Other:
Clear selection
Location of Event:
*
Your answer
Please provide a brief description of your event:
*
Your answer
What type of speaking engagement are you interested in having Maria offer?
*
Workshop
Series of Workshops
Keynote/Motivational Speech
Panel
Other:
Will your organization provide travel accommodations for Maria and her executive assistant to attend your event? (If applicable)
*
Yes
No
Maybe
N/A
How long do you expect this speaking engagement to be?
*
1-hour or less
1 - 2 hours
More than 2 Hours
Other:
Will Embrace Her Legacy have the opportunity to have a display table at your event? (If applicable)
Yes
No
N/A
Other:
Clear selection
How many attendees will be at your event?
*
Your answer
Briefly describe the demographics or profile of your event attendees. (Ex: College Students, Businesswomen, etc.)
*
Your answer
What takeaway do you want attendees to walk away with from this speaking engagement? (Ex: achieve personal goals, leadership development, personal development, build confidence, etc)
*
Your answer
Do you have a preferred topic you want Maria to discuss?
*
Your answer
What's your budget for speaker honorarium fees?
*
$500 - $1,000
$1,000 - $2,500
$2,500 - $5,000
$5,000 - $7,500
$7,500 - $10,000
We do not have a budget for speaker fees.
Other:
Please provide any website or social media links to your organization or event if available.
Your answer
Submit
Clear form
Never submit passwords through Google Forms.
This form was created inside of Embrace Her Legacy.
Report Abuse
Forms
