JavaScript isn't enabled in your browser, so this file can't be opened. Enable and reload.
Request Anita to Speak at Your Next Event or Train Your Leaders!
This form is used by the Coach Anita Team to schedule her speaking and training calendar of events. Please fill out this form to the best of your knowledge and a member of our team will get back to you ASAP :)
Sign in to Google
to save your progress.
Learn more
* Indicates required question
Email
*
Your email
Your Name
*
Your answer
What is the theme of your event and what exactly would you like Anita to speak about?
*
Your answer
Are there any specific "feelings, thoughts, inspiration" you would like your attendees to leave with? If so, what are they?
*
Your answer
Are you expecting audience participation, breakout groups, etc.
*
Yes
No
Event Name
*
Your answer
Event Date
*
MM
/
DD
/
YYYY
Event Location; Virtual or In-Person, City, State
*
Your answer
How Many Attendees Do You Expect?
*
Your answer
How would you like Coach Anita to participate?
*
Keynote
Speaker
Trainer
Panelist
Briefly tell us about your event and how you would like Coach Anita to participate?
*
Your answer
Coach Anita Charlot's speaker fees begin at $2,500, depending on what role you want her to play - can you make that investment now?
*
Yes, Of Course.
Unfortunately No-Not at this time.
Are there any other details about the event that the team should be aware of?
*
Your answer
Send me a copy of my responses.
Submit
Page 1 of 1
Clear form
Never submit passwords through Google Forms.
reCAPTCHA
Privacy
Terms
This content is neither created nor endorsed by Google.
Report Abuse
-
Terms of Service
-
Privacy Policy
Forms
