Booking/Holding Date Request

Please complete the following form to hold or book a date or to request more information about our availability, and include information about the event you are planning.

It is NOT binding; it is only a 14 day hold on a date from the time you submit your request.

Simply fill out this form, click submit and we will contact you as soon as possible.

* Denotes required field.

* Full Name

* School/Organization

Title

Street

Apt #

City

State/Province

Zip Code

Phone

* Email Address

What type of programs are you interested in? Keynote Presentations Workshop(s) Training Retreat Consultation

What area of interest? Developing Student Leaders Increasing Student Retention Transforming Campus Conflict Corporate

* For Which Dates?
(Enter as many dates as necessary; one per line)

What length program? 1 hr keynote 1/2 day [3-4 hrs] full-day no more than 2 days no more than 3 days more than 3 days

* Approx. Number of People in Attendance: Less than 25 25-50 50-75 75-100 100-150 150-200 200-300 300-500 500-1000 more than 1000

The Goals and Objectives of the Planned Event

How Did You Hear About Us?

Yes, send me your periodic ezine

Send

Please double check to be sure all the information you entered is correct and click send request.