Information Request

Do we have a match?

You can tell me your needs by filling out this form and clicking on the Submit button below. (Note: This isn't a binding document.)

Your Name (required)
Your E-Mail Address
Your Telephone Number (required)
Your Company (optional)
Your Street Address (required)
Your City, State, & Zip Code (required)

1. Please check the type of presentation(s) in which you are most interested.

   Key Note   Breakout   Retreat   Staff Development   Guest Speaker   White Hair, Wit & Wisdom

  Club 100!   Club 100 Plus!  

2. Size of audience is approximately:   20-50   50-100   100-300   300-500   Over 500

3. Purpose for the presentation?

4. Demographics of the Audience:   Seniors   Men   Women   Teens

5. If you are interested in the PRESENCE series, which presentation(s) interest you the most?

     You are a Gift   Born to Succeed   The Master Plan  

6. Are you considering a special time period Seasonal/Liturgical?    Other   

7. How would you like me to contact you?    U.S. Mail   E-Mail    Telephone  


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2011 by Jeanne Rogers