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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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