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Invite Dr. Juliana to Speak at Your Event

[/et_pb_text][/et_pb_column][/et_pb_row][et_pb_row _builder_version=”3.0.47″ background_size=”initial” background_position=”top_left” background_repeat=”repeat” _i=”1″ _address=”0.1″][et_pb_column type=”4_4″][et_pb_contact_form email=”contactdrjuliana@gmail.com” success_message=”Thanks for sending your request. We’ll be in touch if there’s a fit!” submit_button_text=”Submit Your Event” _builder_version=”3.0.76″ module_id=”et_pb_contact_form_0″] [et_pb_contact_field field_id=”Name” field_title=”Name” _builder_version=”3.0.76″][/et_pb_contact_field][et_pb_contact_field field_id=”Email” field_title=”Email Address” field_type=”email” _builder_version=”3.0.76″][/et_pb_contact_field][et_pb_contact_field field_id=”date” field_title=”Date of Event” fullwidth_field=”on” _builder_version=”3.0.76″ form_field_font=”||||” use_border_color=”off”][/et_pb_contact_field][et_pb_contact_field field_id=”location” field_title=”Location of Event” fullwidth_field=”on” _builder_version=”3.0.76″ form_field_font=”||||” use_border_color=”off”][/et_pb_contact_field][et_pb_contact_field field_id=”budget” field_title=”Speaker Budget” fullwidth_field=”on” _builder_version=”3.0.76″ form_field_font=”||||” use_border_color=”off”][/et_pb_contact_field][et_pb_contact_field field_id=”travel” field_title=”Will flights and accommodations be covered by you?” field_type=”checkbox” checkbox_options=”%91{%22value%22:%22Yes%22,%22checked%22:0},{%22value%22:%22No%22,%22checked%22:0},{%22value%22:%22Other (please explain below)%22,%22checked%22:0}%93″ fullwidth_field=”on” _builder_version=”3.0.76″ form_field_font=”||||” use_border_color=”off”][/et_pb_contact_field][et_pb_contact_field field_id=”number_of_attendees” field_title=”Approximate Number of Attendees” fullwidth_field=”on” _builder_version=”3.0.76″ form_field_font=”||||” use_border_color=”off”][/et_pb_contact_field][et_pb_contact_field field_id=”topic” field_title=”What topic are you looking for Dr. Juliana to speak about? (If you aren’t sure, tell us more about your event and audience below)” fullwidth_field=”on” _builder_version=”3.0.76″ form_field_font=”||||” use_border_color=”off”][/et_pb_contact_field][et_pb_contact_field field_id=”audience” field_title=”Tell us a bit about your audience…” field_type=”text” fullwidth_field=”on” _builder_version=”3.0.76″ form_field_font=”||||” use_border_color=”off”][/et_pb_contact_field][et_pb_contact_field field_id=”event” field_title=”Tell us a bit about your event…” field_type=”text” fullwidth_field=”on” _builder_version=”3.0.76″ form_field_font=”||||” use_border_color=”off”][/et_pb_contact_field][et_pb_contact_field field_id=”additional” field_title=”Anything else we should know?” field_type=”text” required_mark=”off” fullwidth_field=”on” _builder_version=”3.0.76″ form_field_font=”||||” use_border_color=”off”][/et_pb_contact_field] [/et_pb_contact_form][/et_pb_column][/et_pb_row][/et_pb_section]