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Embracing My Natural, Inc. Event Interest Form
Please complete this form if you are interested in
Embracing My Natural, Inc.
facilitating an event for your organization, business, school, etc. We are open to event ideas!
Learn more about our past events at
www.embracingmynatural.org
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* Indicates required question
Email
*
Your email
Today's date
*
MM
/
DD
/
YYYY
Please provide a person of contact (first and last name):
*
Your answer
What is the name of your organization, business, school, etc.?
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Your answer
Where are you located?
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Your answer
Do you classify as a public, private, charter school, college or university?
*
Yes
No
Do you classify as a non-profit organization?
*
Yes
No
Do you classify as a minority-serving organization, business, school, etc.?
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Yes
No
What is your website and/or social media information?
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Your answer
How would you like your event delivered?
*
In-person
Virtual
Hybrid (both in-person and virtual component)
Google classroom (or similar platform)
Other:
Required
Where will the event be located?
*
Your answer
What is the proposed event date?
*
MM
/
DD
/
YYYY
What is the proposed event time?
*
Time
:
AM
PM
What is the length of your proposed event? How long do we have to complete our portion of the event?
*
Your answer
What is your projected audience size and composition?
*
Your answer
Will there be access to media (microphone, podium, laptop for presentation, internet, etc.)?
*
Your answer
Would you like to include products for the event as a part of your package? If so, what products?
*
Embracing My Natural, Inc. Coloring Books
Head Wraps
No products are needed for the proposed event
Other:
Required
Do you have a budget for this event? If so, what is your proposed budget for this event (speaker budget)?
*
Your answer
What date would you like a speaker confirmation?
*
MM
/
DD
/
YYYY
Please provide any other helpful information about your event. Include event ideas. All ideas are welcomed!
Your answer
A copy of your responses will be emailed to the address you provided.
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