Helping you find the perfect speaker for your seminar, conference or board retreat is our goal. Please fill out the information below as completely as possible and someone from our team of experienced educational program planners will contact you by phone with suggestions for speakers.

* REQUIRED FIELDS

Contact Information
*Name:
Title:
Organization:
Address:
City:
State:
Zip:
*Phone:
*E-mail:

Event Information
Type of event:
Number of attendees:
Date(s) of event:

Are you able to change the date(s)?

Yes No
Time of day of speaking engagement:
Location of travel: (City, State)
Closest recommended commercial airport:

We are looking for a...

Keynote presenter
Breakout presenter
Presentation moderator
Group facilitator

Please indicate the length (in hours)
of the presentation/facilitation:

hours

Are you looking for a speaker to present multiple presentations on different subjects?

Yes  No

Please indicate your budget
allocation for a single speaker:

$4,000 - $5,999
$6,000 - $7,999
$8,000 - $9,999
$10,000 and above

Requested Speakers:
Please indicate the speakers you would like to request:
Barry Asmus Kristin Baird Kathleen Batholomew
Jeff Bauer Bruce Berger Sam Bierstock
Errol Biggs Chris Blackmore Joseph Bujak
Paula Butterfield John Byrnes Teena Cahill
Andrew Carle Susan Cejka Anthony Cirillo
Kenneth Cohn Barry Dorn M. Tray Dunaway
William Dwyer Robert Elliott Bill Felkey
Emily Friedman Mark Hagland Jim Harris
Christopher Irelan Jay Kaplan Nathan Kaufman
John Kenagy Robert Laszewski Charles Lauer
Susan Lawrence & David Mashore Fred Lee Wendy Leebov
James Lloyd Natalie Manor Scott Mason
Martin Merry Joseph Michelli John Nance
David Nash Edward O'Connor Anthony Paquin
Dennis Pointer James Reinertsen Diane Sieg
Michael Taylor Maria Todd Art Turock
Steven Valentine Donald Wegmiller

Comments and Topic Areas:
Please indicate the major focus of your event, and the topics/challenges that are of greatest interest to your organization. Also include any comments and/or special requests.


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