MOTIVATE YOURSELF BOOKING FORM

Hello once again!

Below, you'll find a form that you can fill out if you're interested in booking me into your school, conference, camp, sorority, fraternity, or any other event you can imagine. Just fill in all of the information below so that I can properly address your needs. You will receive a reply within 24 hours.

Thank you for getting in touch with me, and I look forward to working with you to bring me out to your event!

Your Full Name
Your School Or Group Name
Your Position
Where Did You Find Me From?
What Type Of Event Are You Holding?
Which Program Would You Prefer?
How Many Students Will Be Attending?
How Many Speeches Do You Require?
Would You Also Like My Student Leadership Workshop?
City
Province/State
Postal Code/Zip Code
E-Mail *PLEASE DOUBLE CHECK YOUR E-MAIL*
Contact Phone #
Date Prefered
Interested in having me speak for your feeder schools
Interested in purchasing Motivate Yourself Bracelets for audience particpants?
Comments

TESTIMONIALS

"Hey. . . It's been over year since I heard you speak, yet your words have stuck with me. Thank you for REALLY being a motivational speaker, and I too hope that the world hears and learns your message. :-) :D"
---Dierre Upshaw, HOBY Ohio North, May 2002 & 2004

MOTIVATE YOURSELF BOOKING FORM

CONTACT INFO:

TESTIMONIALS