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Speaking & Group Request Form

First Name

Last Name

Email

Position/Job Title

Company

How Did you Hear About Colon Therapy Works?

Is This A Speaking or Group Event?

What Topic Would You Like To Have K. Williams Speak On? (Speaking Events Only)

Will This Event Be In Person, Virtual, or Hybrid?

What Is The Expected Attendance /Participation For Your Event?

What Type Of Audience Do You Expect To Be In Attendance? (Speaking Events Only)

Students

Health & Wellness Practitioners

Business Owners

Health & Wellness Enthusiasts

Other (Please Sepcify In Notes Section Below)

What Is The Anticipated Date(s) & Time For Your Event?

to

Time

to

Time

What Is Your Budget For Your Event? * Required

<$2,000

$2,000-5,000

$5,000-$7,000

$7,000+

Unknown

Please Feel Free To Add Any Other Notes, Comments, Or Thoughts Related To Your Event

Thank You For Your Interest! A Member Of Our Staff Will Reach Out In 1-2 Business Days

Contact
Details

Ph: 470-418-5117

Email: colontherapyworks@gmail.com

©2023 by Colon Therapy Works

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