Booking Form Those ready to have audiences uplifted with Mark & Shannon’s life-changing presentation, please contact their Speaker Manager at: Speaker@MyBigImpact.com. Once your event is approved, you will be asked to complete this form. To complete the form, please fill out the fields below and click Submit at the bottom. Only forms that are filled out using this online function will be considered. No handwritten forms will be accepted.Event Title*Organization*Date of Event* Date Format: MM slash DD slash YYYY Time of Event* : HH MM AMPM Event Location*Event Room (if applicable)Primary Contact*Address* Street Address City State / Province / Region ZIP / Postal Code Country AfghanistanÅland IslandsAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarrussalamBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongo, Democratic Republic of theCongo, Republic of theCook IslandsCosta RicaCôte d'IvoireCroatiaCubaCuraçaoCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatini (Swaziland)EthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacauMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth KoreaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRéunionRomaniaRussiaRwandaSaint BarthélemySaint HelenaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth GeorgiaSouth KoreaSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan Mayen IslandsSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTurks and Caicos IslandsTuvaluUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUS Minor Outlying IslandsUzbekistanVanuatuVenezuelaVietnamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabwe Primary Contact*Contact Email* Contact Phone Number*Phone TypeHomeOfficeCell phoneWebsite*The ProgramProgram Theme*Objectives for the Event*What takes place immediately BEFORE Mark & Shannon's presentation?*What takes place immediately AFTER Mark & Shannon's presentation?*Name*Title*Start* : HH MM AMPM End* : HH MM AMPM Are you planning to audio or videotape the presentation?*What will the recordings be used for?*Is the event:*PrivateOpen to PublicAudienceNumber of Attendees Expected*Demographics*Is there anything Mark & Shannon should know about the audience before addressing them?*Travel and AccommodationsWho will be making travel arrangements? (hotel, car, airfare)*Hotel where Mark & Shanon will be staying (they prefer a hotel with gym, non-smoking, king sized bed, charged to master account for room and tax)*Hotel Phone*Hotel Fax*Confirmation Number*Closest Airport to hotel*Distance of Hotel from Airport*Distance of Event from Airport*Distance of Event from Hotel*Who will be picking up and returning Mark & Shannon to the airport?Company*Name*Phone Number*Cell Phone*Where will the driver meet Mark & Shannon?*Baggage ClaimCurbsideProductsWould you like Mark & Shannon to do a special/ additional training for your audience BEFORE the event (interview on FB Live, Belive.tv, Zoom training, etc)?*YesNoIf so, what platform?What link or login info?May Mark & Shannon make an irresistible offer to your audience?*YesNoLocation to ship handbooks and products if applicable*Additional InformationDress Code*Secondary Contact Person at the Event*Audio/visual requirements. Mark & Shannon need two separate microphones. They prefer countryman microphones If not available, their second choice is two lavaliere microphone. Is this possible?YesNoMark & Shannon also need a projector and a projector screen for their presentation. Is this possible?YesNoWill an email list of participants be provided after the event?YesNoFeesWho is responsible for reimbursements if applicable?*Please indicate below for each category:Airfare*Your organizationMark & ShannonHotel*Your organizationMark & ShannonMeals*Your organizationMark & ShannonTransportation*Your organizationMark & ShannonOther*Your organizationMark & ShannonAmount of Honorarium - $You will be invoiced for a non-refundable deposit of half the honorarium due upon receipt. The balance will be due on or before the date of your event. If Big Impact Inc. incurs the airfare expense, Big Impact Inc. will bill this in advance of the event. Hotel and other expenses will be billed after the event. All expenses incurred by Mark & Shannon or Big Impact Inc in regards to your event – including but not limited to airfare, hotel, car rental, meals, ground transportation to and from the airport or his hotel and home – will be reimbursed within 30 days of the event. Please indicate where the invoices and expenses are sent in field at the bottom of this page. Please return to: Jennifer Ellis, Speaker Liason E-mail: Speaker@BigImpactLive.com This iframe contains the logic required to handle Ajax powered Gravity Forms.