Speaker Request FormPlease enable JavaScript in your browser to complete this form.Name *FirstLastStreet Address *Street Address (Line 2)City *State *Postal/ Zip Code *Phone (include area code + phone number) *Date of Event *MM/DD/YYYYTIme of Event *00:00 AM or PM (Example, 2:00 PM)Name of Event *Expected Number of Attendees *What kind of event? *SummitConferenceBook SigningChurch Service/Prayer Breakfast/RetreatBook SigningOtherWhat is your Speaker/Trainer budget? *What kind of appearance would you like Jocelyn to make at your event?Host/FacilitateBreakout SessionKeynoteTrainerPanelistOtherAre there any sensitive issues I should be aware of or topics I should avoid? And if so, what are those topics? *What are some of the current problems/challenges/breakthroughs experienced by your attendees, industry, organization, association or people? *What specific topics would you like Jocelyn to discuss? *Is Jocelyn able to sell products at this event? *YesNoPhoneSubmit