College Campus Offer

Request for Services

Thank you for clicking your way to my form. This is the first step toward our creating a mutually beneficial relationship. By filling out this form, you are indicating your desire to have me present on your campus in return for your providing me with footage of the event.

Question Title

* 1. College/University

Question Title

* 2. Department

Student Activities

Student Affairs

Career Services

Other (please specify)

Question Title

* 3. Contact Information

Name

Title

Address

Address 2

City/Town

State/Province

ZIP/Postal Code

Email Address

Phone Number

Question Title

* 4. Please indicate which theme you are interested in my presenting on your campus (indicate all that apply)

The Power of CARE

What Color Is Your Imagination?

The Promising Professional

Other (please specify)

Question Title

* 5. Please indicate what type of event you are interested in sponsoring

"Evening With..." (speaking event)

Keynote Presentation (as part of a larger event)

Workshop (half day: 1.5-3 hours)

Seminar (full day; 4+ hours)

Lunchtime Chat

Other (please specify)

Question Title

* 6. Do you have a date/event in mind already?

Yes, I have a date

No, we are very flexible.

Question Title

* 7. Please describe what type of event you are looking to have.

Question Title

* 8. This question is an affirmative declaration that you understand the "honorarium" for this speaking/training event would be your arranging for the video recording of the event, and your providing me with a flash drive, disk/CD, or FTP of the video footage file(s) upon the completion of the event. If you agree, please type "YES" in the text box.

Question Title

* 9. Please indicate what type of venue is an option.

Classroom

Small Auditorium/Theater

Large Auditorium/Conference Space

Other (please specify)

Thank you for your interest in this offer. I will be in touch with you shortly to discuss this potential relationship and possible dates.

Nadine Owens Burton