Chamber of Commerce 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 at a chamber event in return for your providing me with footage of the event.

Question Title

* 1. Chamber Name

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* 2. Contact Information

Name

Title

Address

Address 2

City/Town

State/Province

ZIP/Postal Code

Email Address

Phone Number

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* 3. Please indicate which theme you are interested in my presenting (indicate all that apply)

The Power of CARE

What Color Is Your Imagination?

The Promising Professional

Marketing for Non-Profits

Other (please specify)

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* 4. 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)

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

Yes, I have a date

No, we are very flexible.

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

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* 7. 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.

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

Classroom/Conference Room

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