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1. Contact information: (Required.)

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2. What is the location of the event? (Required.)

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3. Date and Time of event? (Required.)

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4. Planned # of attendees: (Required.)

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5. Who else will be speaking: (Required.)

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6. Price to attend this event (If there are packages available... What are the package prices?): (Required.)

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7. Will anything be sold at this event? (If Yes, What will be sold? Price point?) (Required.)

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8. Speaker Budget: (Required.)

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9. What is your attendees primary focus in life? (Required.)

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10. Is there a specific profession that most of your attendees would be grouped under? (Required.)

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11. What is the biggest PROBLEM your attendees faces? (Required.)

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12. What do your attendees want MOST in life? (Required.)

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13. What do you feel is keeping them from achieving what they want most? (Required.)

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14. What topic(s) would you like Jairek to focus on during the Speech/workshop? (Required.)

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15. How did you become aware of Jairek Robbins? (Required.)

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16. Please list 3 references and their contact (e-mail/Phone) (Required.)

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