A Vision in Motion, Motivational Speakers Bureau
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    Colleges and Universities

    Please complete the following form and a Vision in Motion representative will promptly respond to your inquiry. We ask that you provide as much specific information as possible so we can most effectively serve you. Our presentations will be customized to fit the program topic and grade levels of the students attending your college or university.

    Enter Contact Information

    College or University Name:

    Name of Contact Person
    First Name:

      Last Name:
    Position or Title:

    Daytime Telephone:

      Evening Telephone:
    E-mail Address:

    Mailing Address

      Zip Code:


    Topics for your Target Audience
    What grade levels are you most interested in?    

    Which of the following best describes your college or university?    

    Please check off all of the topics that interest you:

    Orientation Programs Multicultural Awareness
    Residence Life Training Student Life & Leadership
    Drug & Alcohol Education Disability Awareness Days/Months
    Faculty Workshops Guest Speakers for Courses
    Academic Integrity Programs Commencement Address
    Yes, I am interested in residence life & staff development workshops


    Frequency of Desired Programs
    Name a target month (or months) for programs:

    Check here if you want to schedule a speaker right away!
    For your program selections above, which of the following interests you?

    Individual speaker presentations on a particular topic

    Group speaker presentations on a particular topic

    Semester speaker presentations on a variety of topics

    Various programs throughout the academic year
    Have any suggestions or special requests for us? Please describe them below.


    Finding Us on the Web
    How have you heard about A Vision in Motion? (choose one or more)

    Search engine Already a client
    Heard speaker live at an event Referred by a friend, student, or colleague
    Youtube video or twitter Referred by speaker
    Magazine or newspaper Television or newscast
    From mailing Just surfed in
    You will be redirected to the homepage upon submiting this form.

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