Book Dr. Geneva

First Name *

Last Name *

Email *

Number *

Company/Organization *

Name of workshop, seminar, or speaking event *

Date & Time of event *

Is meeting date fixed or tentative?

Address/Location of the event *

Will travel accommodations be needed? Please be advised that Dr. Geneva is in Detroit, MI *

Specific content to be covered? *

Event sponsor(s) *

Expected number of attendees *

Will Media Be Invited? If so, Please Provide the Media List. *

What is your speakers budget? (Include exact $ amount or range) *

How long will you need Dr. Geneva to speak? *

How would you like for Dr. Geneva to contribute to your event? *

Will this speech be followed by a Q&A session? *

Will Dr. Geneva be allowed to promote her products/services? *

Deadline for acceptance (Please provide exact date) *

Any additional information you would like for Dr. Geneva to know or consider? *

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