 First Name: |
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| Last Name: |
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| Organization: |
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| Email: |
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Phone: |
Example: (123) 456-7890 |
| Program Date(s): |
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| Type of event and specific purpose: |
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| Please provide a general description of the audience: |
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| What is the total number of attendees? |
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| Is there a theme for the meeting? |
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| What is your organization's mission statement or company philosophy? |
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| Please provide the specific objectives you desire from my presentation: |
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| Are there any professional challenges facing the individuals in the audience, or your company's industry? |
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| Are there any difficulties currently being faced by your industry? |
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| Describe the most significant changes this group has experienced during the last twelve months: |
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| What are some of the accomplishments this audience has attained? |
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| Please list other speakers presenting at this event: |
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| Please list previous speakers at your company's events: |
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| What takes place immediately before and after my program (meal, break, another session/speaker)? |
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| If this speaking engagement is for a conference, please note the dates/times will the conference begin and end: |
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| Please note the times my presentation should begin and end: |
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| Please provide the name and title of the individual that will be introducing me (introduction supplied): |
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| Meeting Location: |
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Address: |
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| City: |
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| State: |
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| Zip: |
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Phone: |
Example: (123) 456-7890 |
| Distance from Airport: |
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| How will I be transported from the airport to meeting site/hotel? |
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Rental Car |
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Taxi |
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Limo |
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| Name of hotel in which I will be staying? |
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Address: |
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| City: |
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| State: |
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| Zip: |
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Phone: |
Example: (123) 456-7890 |
| Will this hotel room be billed to your master account? |
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Yes |
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No |
| If yes, please provide the Confirmation Number: |
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| Whom should I contact upon my arrival at the meeting site/hotel? |
| Name: |
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Phone: |
Example: (123) 456-7890 |
| Please provide an Emergency Contact: |
| Name: |
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Phone: |
Example: (123) 456-7890 |
| What is the appropriate attire? |
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Kevin Saunders' "Never Give Up! There's Always a Way!" Award
Please use the options below if there will be special recognition at the event. |
| School: K-12 |
| This award recognizes those individuals who have overcome adversity, tragedy, or challenges, or who have worked extra hard to be the very best, academically or athletically. Please list the names of those individuals you would like to recognize and reasons for this recognition. (Please limit your selection to no more than 10 award recipients.) |
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| Colleges & Universities |
| This award recognizes those individuals who have overcome adversity, tragedy, or challenges, or who have worked extra hard to be the very best, academically or athletically. Please list the names of those individuals you would like to recognize and reasons for this recognition. (Please limit your selection to no more than 10 award recipients.) |
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| Business & Corporate |
| This award recognizes those individuals who have overcome adversity, tragedy, or challenges, or who have worked extra hard to be the very best, in reaching and surpassing company goals. Please list the names of those individuals you would like to recognize and reasons for this recognition. (Please limit your selection to no more than 10 award recipients.) |
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| Associations, Organizations & Clubs |
| This award recognizes those individuals who have overcome adversity, tragedy, or challenges, or who have worked extra hard to be the very best, academically or athletically, to be successful or have given of their time and talent to help their community and others to succeed. Please list the names of those individuals you would like to recognize and reasons for this recognition. (Please limit your selection to no more than 10 award recipients.) |
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| Non-Profit Organizations |
| This award recognizes those individuals who have overcome adversity, tragedy, or challenges, or who have worked extra hard to be the very best, academically or athletically, or who given of their time and talents to help others and their community. Please list the names of those individuals you would like to recognize and reasons for this recognition. (Please limit your selection to no more than 10 award recipients.) |
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Would you be interested in my book, There's Always a Way, and other available items?
(The book can be purchased in bulk for your audience members at a discount in advance. Please or call (785) 454-3670 for the amount of discount.) |
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Yes, I would like more information. |
| Is there additional information that I should know? |
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| Please send me updates regarding: |
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Fitness |
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Motivation |
| Please let us know how you heard about Kevin: |
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| Other: |
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