2016 Retreat

Approved Speaker Registration Form

Click here for a type, print and mail version - PDF.
Please send form and payment to:
Gregath Co., PO BOX 505, Wyandotte, OK 74370.  

Information provided here will be used for ongoing PR so please send this in with payment ASAP.

Name: ___________________________________________________________________________

Address: _________________________________________________________________________

Phone Number:_______________________________ 

Preferred Roommate (optional): _____________________________________________________________________________________________  

Non-retreat roommate(s), if applicable: ________________________________________________________

Surnames Researching (for sourcebook): ________________________________________________________

Email: ________________________________  

Website/Blog: ________________________________  

Note any electronic contact information provided may be used online and in PR

Presentation Equipment Requested (podium, digital projector and screen already in room, computer if requested):

_____________________________________________________________________________________________  

 

Comments (include your biographical information for PR):

_____________________________________________________________________________________________  

_____________________________________________________________________________________________  

_____________________________________________________________________________________________

Speakers cannot provide referral bonuses for others - though they are eligible for unlimited referral bonuses for attendees they refer.  

____ Speaker Standard Retreat Package    @ $205.00 = $______________
until September 1, 2016- as available

____ Day Tripper Speaker @ $80.00 - 5 hours (specify day) = $______________
until September 1, 2016 - as available

____ Additional Day Tripper - 5 hours @ $100.00  = $______________
until September 1, 2016 - as available

____ "Single" Supplement @ $60.00  = $______________
until September 1, 2016 - as available

____ Additional Nights @ $120.00 ea (GCI pre-approval needed)  = $______________
until September 1, 2016 - as available

Enclosed is $_______________: This is full payment or down payment (please circle one)

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Page Last Updated: December 21, 2017