Firewalking
Event Request Form

Name *

First

Last

Organization

Email *

Phone Number *

Event Name

Event Date(s)

Event Location

Include City, State, and Venue

Type of Event

Number of Participants

Event Objectives

What are the objectives for your audience participating in the firewalk? (Overcoming fears, team bonding, personal breakthroughs, etc.)

Themes & Outcomes

Is there a specific theme or outcome you want to achieve through firewalking?

Experience Level

Have the participants been exposed to firewalking or similar activities before?

Location Preference

We can provide recommendations if you don’t have a location selected.

Venue Restrictions

Are there any known restrictions or considerations for the venue that need to be addressed?

Event Budget

Additional Activities

Would you like to discuss additional empowerment or team-building exercises?

Follow-up & Support

Are you interested in follow-up sessions or activities to reinforce the firewalking experience?

Coaching for Participants

Would you like information on post-event coaching for participants?

How did you hear about us?

FirewalkingEvent Request Form