BOOKING REQUEST FORM

Thank you for your interest in booking one of our speakers through J. Dorien | The Agency.

Please share a few details about your event so we can better understand your needs and connect you with the right voice for your audience.

1. Contact Information

Let’s start with your details so we can follow up quickly.

Full Name *

Organization / Company Name

Phone *

Email *

Website (if possible) *

2. Event Details

Tell us a bit about your upcoming event.

Name of Event *

Event Date *

Location of Event *

Estimated Size of Audience *

Under 50

50-200

200-1,000

1,000+

Audience Type (e.g. corporate leaders, educators, wellness professionals, general public, etc.) *

Theme of Event / Focus *

3. Speaker Interest

Who would you like to bring to your stage?

Please select the speaker you’re interested in. *

Sid McNairy, World Peace Ambassador
Dr. Shelley Best, The Creative Disruptor
Dr. Ray Baxter, Leadership Authority
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What type of appearance are you seeking? *

Keynote Presentation

Workshop or Masterclass

Panel Discussion

Interview / Media Appearance

Other

4. Budget & Logistics

These details help us tailor the right experience for your audience.

What is you estimated speaker budget? *

Under $5,000

$5,000-$10,000

$10,000-$20,000

$20,000-$35,000

35,000+

Unsure / Discuss with my team

Does your budget include travel and lodging? *

Yes

Virtual Event

Are you partnering with a planner or team to organize the event? *

Yes

Undecided

5. Additional Notes (Optional)

Anything else we should know?

6. Confirmation

How did you first hear about J. Dorien | The Agency? *

Website

Referral

Social Media

Event

Other

Consent

I understand that completing this form is an inquiry and does not guarantee booking. I agree to terms & conditions provided by the company. By providing my phone number, I agree to receive text messages from JDorien, LLC.

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