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BOOKING FORM
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* Indicates required question
Name of Organization
*
Your answer
Type of Organization
*
For Profit/Corporate
Non-Profit/Church
College/University
Contact person's mobile phone
*
Your answer
Contact person's email
*
Your answer
Date(s) of Speaking Session(s)
*
Your answer
Type of Event, the Theme, and Event Times (e.g 6pm -9pm.)
*
Your answer
Will Host cover airline flights and baggage, rental car & gas, hotel for the speaker, spouse/travel assistant?
*
Yes
No
Not Applicable
Other:
Honorarium
*
$1,000
$1,500
$2,500
$5,000
$10,000
Other (Document amount below)
Other Amount
*
Your answer
Will there be a table available for product sales?
*
Yes
No
Other:
What equipment will you provide?
*
Projector
TV Display/Screen
Sound System
Audio/Visual Recording of Session
Other:
Required
How did you hear about Us?
*
Your answer
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