| Contact person: |
| Mailing Address: |
| City: |
| Home Phone: |
| Work Phone: |
| Cell Phone: |
| Email: |
| Additional details, Comments: |
| Once your request has been reviewed, we will create a customized proposal for you, and will email it to the address above. Presentations are not confirmed until a signed copy of the proposal and payment have been received. If you need additional information, would like telephone confirmation, or would like to use a coupon, or pay by credit card, please note that in the comments section . Thanks, and we look forward to working with you! |
| State: |
| Zip Code: |
| Sponsoring Organization |
| Proposed workshop location & address |
| Proposed workshop dates |
| Proposed workshop topic |
| Length of time desired |
| Audience size (estimated) |
| Please note: you must click on the TOP of each box in order to type in information! |
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