Winning Life Solutions

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Name of Speaker(s) Requested *:

Name of Host Organization *:

Address *:

Contact info:(tel, fax, email) *:

Primary Contact Person and Position *:

Name of Event *:

Purpose/Goal *:

Scheduled time of event date(s) *:

Length of time speaker is expected to present *:

Number of people expected *:

Describe audience(age, range, sex special needs) *:

Location of Event *:

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Is this an annual event*?

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Is this the first time for this event*?

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We require that all sessions be recorded for DVD and/or CD.

A limited number of private counseling sessions/consultations may be arranged by appointment before/after the engagement. Kindly advise us of any interest in taking advantage of this offer as soon as possible.