Luna Jimenez Seminars Speaker Request Form Please complete and submit the form below to request Luna Jimenez Seminars as a facilitator for your upcoming event. Thanks so much for your interest. All fields are required except where noted.                                                         Section I: Contact info                                      Name:                                    Company/Organization:                                    Title:                                       Street Address:                                      City, State, Zip:                                      Phone number:                                      Email address:                                        Organization or event website URL:                                                              Section II: About the Event                                      Confirmation deadline:                                    Event name:                                    What type of event are you envisioning?                                                                          What is the purpose of this Event?:                                                                           What specific areas or topics would you like addressed?:                                                                                               Is there a working agenda?                                     Who will be the main audience?:                                       Estimated number of participants:                                      Could this number change?      Logistical Information:                                     Date(s) of event:                                                                                       How flexible is this date?                                     Time(s) of event:                                   Event Address:                                   City, State, Zip:                                                               Section III: Information about your organization                         Has Luna Jimenez Seminars ever spoken at your event in the past? :                       What is your working budget?:                          Does this provide for meals, transportation, lodging, etc?:                  Would you be open to one of Nanci’s associates if she is not available?:                                                Are you open to having someone flown in for this event?:                           How important is it that the Facilitator be bicultural/bilingual?:                           Would you be open to providing a videographer or photographer?:                                                                                                                                                                                            Home    Biographies   Seminars  Facilitation  Speaking  Coaching  Calendar  Press Page                                                                                                                                             Copyright © 2008 Luna Jiménez Seminars