Genealogy in the Woods 2011
 Approved Speaker Registration Form

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): _____________________________________________________________________________________________  

_____________________________________________________________________________________________  

______  I am handicapped and have cleared arrangements with _________________________
(for 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. Saturday after dinner, Sunday AM, 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

____ Speaker Full Retreat Package    @ $130.00 each  = $______________
 Until October 1, 2011 - as available
Special Loyalty Invitation speakers will receive their compensation on account or with their camp packet.

____ Day Tripper Packages    @ $TBA each  = $______________
 Until October 1, 2011 - as available

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NO SHIPPING OR HANDLING FEES NEEDED
Page Last Updated: December 21, 2017