Booking Form

First Name

Last Name

Organization

Address of Proposed Venue

Preferred Speaking Dates

Number of Attendees

Contact Number on the Day

Agreed Fee amount (exclusive of VAT)

Considering the attendees and your organization, what would make this presentation a success?

Additional information or expectations?

Name and additional comments

Would it be convenient to sell the Speakers book at the event (all proceeds go to charity)?

Yes

Would it be convenient to display other leaflets/brochures at the event?

Yes

Would it be convenient to video the speech at this event?

Yes

Would you be happy to provide a recommendation or reference after the event?

Yes

Personal requests must be received at least 2 weeks prior to an event.

50% of the agreed payment is due on booking this event.

(to A/c no: 20775075; sort code: 50-00-00 to Natwest Bank, UK. Please note that should payment not be made and the event be rescheduled to a convenient date, there will be no charge. However, if the event is cancelled, there will be a 100% charge.

Thanks for submitting!