Jillian Michaels Speaker Request

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INVITE JILLIAN TO SPEAK AT YOUR EVENT

Jillian Michaels is a popular speaker and has participated in events around the globe in support of a healthier lifestyle. If you are interested in booking Jillian for your event, please provide the following details (items marked with an asterisk * are required).

About the Event
*Name of event
*Date of event:
*Time of event:
*Location (address) of event
*Objective of the event:
*Is the event open to the public?
*Estimated number of attendees:
*Is this a ticketed event?	Price of tickets: $
*How do you plan to advertise/market the event?
*Demographics of the attendees:
*Other speakers booked for this event:
*Description of Jillian's role in the event:

About Your Organization
*Name of company or organization to be listed on the contract
*Name and title of person who will sign the contract:
*Address of company or organization to be listed on the contract:
*Mission statement/description of your organization:
Web site of the event/organization:	http://
*Please provide some examples of previous speakers you or your organization have booked:
*Your budget for Jillian's participation:	$

Your Contact Information
*Your name:
*Your e-mail address:
*Confirm e-mail address:
*Phone number where we can reach you:
*Alternate phone number:
Click the SUBMIT button below to send your request to Empowered Media. Please allow 3-5 days for a response. Thanks for your interest in Jillian!

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