Request Speaking Engagement
 departure from South Florida
 return to South Florida
Generally departs from South Florida: West Palm Beach, Fort Lauderdale, Miami or Boca Raton Airports. Sometimes Jim's travel schedule dictates other points of departure. Generally Jim flies first class and requires a hotel room with high speed Internet access.
 Opening Keynote
 Closing Keynote
 Breakfast Speaker
 Luncheon Speaker
 Dinner Speaker
 After Dinner Speaker
 Present a Workshop
 Moderate a Panel
 Participate in a Panel
 Other, please explain:
 Jim can use a presentation he has given elsewhere.
 Jim can use a presentation he has given previously,
   but not one presented at
  .
 We would like a presentation specifically for our event.

What would you like Jim to bring?
 Nothing - AV & Handouts would be inappropriate.
 Major AV - video, music, multi-screen presentation, etc.
 A nice PowerPoint with appropriate photos & illustrations.
 A simple, all-text PowerPoint.
 Use on-site overhead projectors or easels with paper/markers.
 Handouts to enhance take home value.

Who is the individual we should work with regarding arranging for this presentation?

Name: 
Organization: 
E-Mail: 
Telephone: 
Fax: 
Address: 
City, State, or Province: 
Country: 
Zip or postal code: 


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