Booking Inquiry Form

Eva Palacios - EmpowerYou

Booking Request Form

Please complete this form with as much information as you can and you will be contacted within 24-48 business hours.

First Name *

Last Name *

Role/Title *

Email *

Phone *

Name of School, Organization, Team, Company *

Type of Organization *

Middle School

High School

College/University

Workshop/Conference

Meeting

Real Estate

Other

Website *

Type of Event *

In-Person

Virtual

Pre-Recorded

Date of Event *

Time of Event *

Location of Event

Address *

City *

State *

Postal code *

Estimated Number of Attendees *

Event Attendee Demographics *

Will this event be open to the public? *

Open to the Public

Private event

Do you intend to record or live-stream this event? *

Live Stream

Record

Both

Neither - No capture intended

Can products be sold at this event? *

Yes

No

Details and Goals of the Event *

Speaking Budget *