Information provided here
will be used for ongoing PR so please send this in with payment ASAP.
Please
send form and payment to:
Gregath Co., BOX 505, Wyandotte, OK 74370.
Name: ___________________________________________________________________________
Address: _________________________________________________________________________
Phone
Number:_______________________________
Preferred Roommates (optional): _____________________________________________________________________________________________
_____________________________________________________________________________________________
______ I am handicapped (for dorm reservation purposes only)
Email: ________________________________
Website: ________________________________
(___) Yes! You may use my Web contact information online and in the Syllabus.
(___) NO Do Not use my Web contact information online and in the Syllabus.
Speaking Topic/Requested Time Period - 1 hour before Q&A minimum (i.e. 1hr, 1.5hr, 2hr, etc.): _____________________________________________________________________________________________
Presentation Equipment Requested:
_____________________________________________________________________________________________
Comments:
_____________________________________________________________________________________________
_____________________________________________________________________________________________
_____________________________________________________________________________________________
Speakers can not provide referral bonuses for others - though they are eligible for unlimited referral bonuses for attendees they refer.
Please also include biographical information and a photo.
Price includes Speaker Discount
____ Standard Full Retreat Package Enclosed = $100.00
Day Tripper (1 day) Offer - Inquire
Ask about our referral bonus.
NO
SHIPPING OR HANDLING FEES NEEDED
Page Last Updated:
December 21, 2017