Book Dr. Goodbinder

Name

First Last

Phone

Email

Speaking Topic

Event Date

MM slash DD slash YYYY

Event Time

Hours

:

Minutes

AM/PM

Event Location Name

Event Address

Street Address Address Line 2 City State ZIP Code

Multiple Presentations Needed

Yes

No

Audience Size

Describe the Audience. What do they do?

What are their challenges?

What do They Need to Learn/Take Away from this Session?

What A/V Equipment is Available?

Will you Film the Event?

Yes

No

Is there Internet Access Available?

Yes

No

Is there a Vendor Table Available for Books/Products Sales?

Yes

No

Are You Interested in Purchasing Books for the Audience?

Yes

No

What is Your Budget for this Presentation?

What are the Guidelines for Travel Budget and Arrangements? (Should we book the travel or will your company handle that?)

Additional Information

Email

This field is for validation purposes and should be left unchanged.