Event Request

Name*
First Last
Phone*
Email*
Date of Event*
Date Format: MM slash DD slash YYYY
Name of Event*
Have you been a vendor at this event or with these organizers before?*
If so, what were the prior results in general?
Address of Event*
Street Address City State / Province / Region ZIP / Postal Code
Amount of people expected at the event?*
Number of booths you plan to order?*
LumiCeutical Support Requested*
Due Date for that support*
Date Format: MM slash DD slash YYYY
Names of Lumi owner/ambassadors working at the event?*
List Each Name On New Line
Will Lumi be the exclusive product promoted at the booth?*
- Yes
- No
- Not Sure
If not, what else will be promoted/included?*
Is there a speaking opportunity included?*
- Yes
- No
- Not Sure
If so, who is the speaker?
Need Support With?
Need Support*
Mark All that Apply
Need Support*
Mark all that apply
Signs- How Many?
Chairs- How Many?
Blankets- How Many?*
Brochures?- How Many?*
Other-
Tell Us What Other Support You Require
How will Lumi gain from this exposure?
Examples would be social media promos, newsletter exposure, website exposure, facebook live videos, photos, testimonials, feedback waivers that will be added to newsletter list, intended number of new renters, and intended number of new owners.
Pre Event:*
During Event*
Post Event*
Costs that will be handled by the Ambassador?*

Need Support With?