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Please tell us about your event by completing this form!
Name of your organization or company
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Organization contact phone number
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Contact person filling out this form.
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Position with the organization or company
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President/C.E.O
Secretary
Event Marketing/Public Relations
Company representative
Client Contact phone number
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Client email address
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Address of client to send contract for signing
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Please explain your organization or event purpose so that our representatives will have a clear understanding of your products and services.
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Your company/organization Information
Name of organization/Conference lead representative
Name of organization/Conference lead representative contact number
Your Program/Event Information
Please select the following services you are inquiring for Motivating Youth
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Sponsored teen performing at your event
Keynote speaker at your event
Hosting a workshop at your event
Who should we contact upon our arrival at your event?
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What number should we call for this person?
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What email should we use for this person?
Name or Theme of the event
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Date of event
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Time of event (e.g. 3:00p - 7:00p)
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Name & Address of event Venue (City, State, Zip)
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Anticipated number of attendees
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Please explain your event purpose and how you would like the Motivating Youth Company to help. We want to meet the goals that you have for us, please explain thoroughly the goal(s) that you would like for us to accomplish, and we will go beyond.
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Dress attire for your event
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Entertainment/Speaker(s) budget for the event.
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Will you need MYC to complete a W-9
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Yes
No
Will meals, mileage and hotel be accommodated for our representatives.
Yes
No
If yes, please indicate how your organization calculate meals, mileage and hotel costs. (e.g 0.5m, 1 meal nightly, 2 night free stay at local hotel, etc)
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WORKSHOP DETAILS
Please complete this section below if you would like The Motivating Youth Company to provide workshop(s) during the course of your conference, event or program.
Were you interested in having the Motivating Youth Company present a workshop during the course of your event?
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Yes
No
If you were how many would you like for us to present?
1
2
3
4
5
How long will each workshop last?
Please tell us specifically what you would like for us to cover during each workshop session? (For example: If you would like MYC to present (2) workshops, please explain what topics you would like for MYC to present during workshop #1. Then tell us the goal you would like for us to meet for workshop #2)
Counselor(s), Mentor(s), Speakers Requests
Preferred Motivating Youth Speaker(s), Counselor(s), Mentor(s)
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Speaker(s), Mentor(s), Counselor(s) arrival time
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Please List exact location you would like for them to arrive
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Presentation start time
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Presentation end time
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Total Time
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15
25
30
40
45
1 Hour
1 Hour & 30 Minutes
2 Hours
General Accommodations/Questions
Will you be able to provide a lapel Mike
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Yes
No
Handheld wirless microphone only
handheld wired microphone only
If you selected yes for lapel mikes how many can you provide.
1
2
3
4
5
If you selected yes for a handheld mike how many will you be able to provide.
1
2
3
4
5
Will you allow the Motivating Youth Company to record and take pictures at your event, and providing you with professional copies less than one week later?
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Yes
No
Will you be able to email us a picture(s) of your stage and arena which we will be performing on.
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Yes
No
If possible please submit an itinerary of event.
THANK YOU FOR COMPLETING OUR EVENT QUESTIONNAIRE. We look forward to sending a completed contract to be signed or corrected with signatures to you in 3 to 4 business days after the submission of this form.
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