First Name:

Last Name:

Title (Optional)

Company Name:

Contact Number:

Contact Mobile No:

Contact E Mail:

1.What services do you require?

-Public Relations campaign-Corporate Public Relations-Strategic Communications-Media Training-Media Services-Media Relations-Digital Marketing-Corporate Branding- Other (specify needs)

2.Media Training

2.1.How many delegates need to attend the Media Training session?

minimum of 4 delegates for 4 to 6 hour sessionminimum of 4 delegates for 8 hour sessionminimum of 1 delegate for private coaching session for VVIP’s -corporate executives, country Presidents and mayors, country ambassadors and HNWI

2.2.Preferred venue for Media Training session

boardroom or officemeeting venues and hotelsvirtualother (specify)

2.3.Preferred date/s for the Media Training session

Option 1 - priority

Option 2

Option 3

2.4.Preferred city or town for the Media Training session ( if face to face)

(Specify – Pretoria, Cape Town, Mbombela, Durban, etc.)

2.5.Preferred Media Training package – 4 to 6 hour session or 8 hours session

4 to 6 hour session8 hours session

2.6.Any additional requirements to be included for the Media Training session