A Vision in Motion: Speakers Bureau: Scheduling Corporate Keynotes & Seminars

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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 department level of the employees within your company or organization.


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

Topics for your Target Audience
What size is your organization?
Which of the following best describes your work environment and employees?
Please check off all of the topics that interest you:
Employee Productivity		Multicultural Awareness
Sensitivity Training		Effective Time Management
Disability Awareness		Communication Skills & Teamwork
Life & Family Enhancement Topics		Spousal Workshops & Programs
Keynote Address		Conference Workshops & Seminars
Yes, I am interested in employer and employee 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 Quarterly speaker presentations on a variety of topics Various programs throughout the fiscal year
Have any suggestions or special requests for us? Please describe them below.

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