Journey To My Destiny – Booking Request Form

Please complete this form in its entirety as all of the information you provide will assist in the booking process. Please be aware that this serves only as an invitation, NOT a confirmation. It will merely assist us in making the best possible decision while doing all that we can to meet your request. Thank you!

Name *

First

Last *

Last

Phone

Email *

Street Address

City

State

Zip code

* Is this request for

Date(s) of your event? *

Date of presentation: *

Time of presentation:

Length of presentation:

Requested topic:

Honorarium: *

Yes

Expected Attendance:

Sponsoring organization *

Website

Type of event: (conference, luncheon, etc.)

Venue of event (hotel, convention center, church, etc.): *

Address of event venue

Street *

City *

State *

Zip code *

IF YOUR REQUEST IS REGARDING A WOMEN’S RETREAT, PLEASE SELECT ONE OF THE FOLLOWING OPTIONS

ULTIMATE RETREAT (1 OVERNIGHT STAY)

SIGNATURE RETREAT (1 OVERNIGHT STAY INCL. SIGNATURE ITEMS) BODY & SOUL RETREAT (2 OVERNIGHT STAYS INCL. HEALTH & FITNESS)

Other pertinent information: *

Thank you for your interest. We will contact you upon receipt of your completed form.

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