A Vision in Motion Speakers BureauContact Us
Your resource for speakers who REALLY make a difference!

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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 department level of the employees within your company or organization.

Enter Contact Information

Company or Organization Name:

Name of Contact Person
First Name:

  Last Name:
Position or Title:

Daytime Telephone:

  Evening Telephone:
E-mail Address:

Web Site Address:

Mailing Address

  Zip Code:


Topics for your Target Audience
What size is your organization?    

Which of the following best describes your work environment and employees?    

Please check off all of the topics that interest you:

Employee Productivity Multicultural Awareness
Sensitivity Training Effective Time Management
Disability Awareness Communication Skills & Teamwork
Life & Family Enhancement Topics Spousal Workshops & Programs
Keynote Address Conference Workshops & Seminars
Yes, I am interested in employer and employee 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

Quarterly speaker presentations on a variety of topics

Various programs throughout the fiscal 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 or colleague
Youtube video or twitter Referred by speaker
Magazine or newspaper Television or newscast
From mailing Just surfed in
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