Dr. Ed/WE Rise Media
Engagement Discovery

The following form will assist us properly evaluate and prepare for your event. Please complete all applicable information. For questions regarding this form
please call 678-598-3836 or email us at admin@ManRiseUp.com

Download Media Kit

Name of Sponsoring Organization *

Event Location *

Date and Time of Event

Expected Number of Attendees *

How did you hear about Dr. Ed Womack and/or WE Rise Media *
0/1000 characters

Describe the nature of event and any specific topics Dr. Ed should cover (Theme, Purpose, etc.) *
0/1000 characters

Are there any sensitive issues that should be avoided? *
0/100 characters

What is the expected time allotted to Dr. Ed for Workshop/Presentation *

What is the Attire for Event? *

Date and Time Dr. Ed is expected to arrive? *

Dr. Ed/WE Rise Media travel expenses are reimbursable? *

Wil Ed/WE Rise Media be allowed to setup product table at event? (Books, CD’s, T-shirts etc.)? *

The following Audio Visual aids are available at venue *

LCD/Projector

HDMI enable big screen

Projection Screen/Blank Wall

Presenters Table or Lectern

What is the budgeted speaker fee for this event? *

Contact Person *

Contact Person’s Phone # *

Contact Person’s Email Address *

Street address of Organization *

Address Line 2 Bldg/Suite# *

City *

State *

Zip Code *

Ed Womack Speaks