A Vision in Motion: Speakers Bureau: Scheduling College/University Programs

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Please complete the following form and a Vision in Motion representative will promptly respond to your inquiry. We ask that you provide as much specific information as possible so we can most effectively serve you. Our presentations will be customized to fit the program topic and grade levels of the students attending your college or university.


Enter Contact Information
College or University Name:
Name of Contact Person
First Name:		Last Name:
Position or Title:
Daytime Telephone:	Evening Telephone:		Fax:
E-mail Address:
Mailing Address
Street:
City:		State:	Zip Code:

Topics for your Target Audience
What grade levels are you most interested in?
Which of the following best describes your college or university?
Please check off all of the topics that interest you:
Orientation Programs		Multicultural Awareness
Residence Life Training		Student Life & Leadership
Drug & Alcohol Education		Disability Awareness Days/Months
Faculty Workshops		Guest Speakers for Courses
Academic Integrity Programs		Commencement Address
Yes, I am interested in residence life & staff development workshops

Frequency of Desired Programs
Name a target month (or months) for programs:
Check here if you want to schedule a speaker right away!
For your program selections above, which of the following interests you? Individual speaker presentations on a particular topic Group speaker presentations on a particular topic Semester speaker presentations on a variety of topics Various programs throughout the academic year
Have any suggestions or special requests for us? Please describe them below.

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