To determine Terry Watson's speaking fee for your speaking engagement, please complete the following form. We will then determine the fee and return the request with the fee listed. After you submit this form, you wil have the opportunity to print a summary of the request for your records.

CONTACT INFORMATION
Your Name/Representative:
Sponsor/Company Name:
Billing Mailing Address:
City/State/Zip:	/ /
Your Office Phone Number:
Your Cell Phone Number:
Your Email Address:
EVENT INFORMATION:
	The Name of the Class(es)/Course(s)/Keynote Topic:
Location of the Event:
Date of the Event:
Name of Event:
Number of Days:		Speaking Time (Start to Finish):
Hours per Day:		Approx. Number of Attendees:
Extra Speaking (extra fee):	No at Breakfast at Lunch at Dinner
CONFIRMATION INFORMATION:
Please Confirm, fax and email our speaking quote to:
Above Contact Below Contact Both
Name:
Fax Number:
Email Address:
Phone Number:
	Enter Security Code: