A Vision in Motion: Motivational Speakers Bureau: Scheduling K-12 School Programs

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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 particular age group and grade levels of the students at your school or organization.


Enter Contact Information
School or Organization:
Name of Contact Person
First Name:		Last Name:
Position or Title:
Daytime Telephone:	Evening Telephone:		Fax:
E-mail Address:
School or Organization web site:

Mailing Address (School or Organization)
Street:
City:		State:	Zip Code:

Home Mailing Address (optional)
Street:
City:		State:	Zip Code:

Topics for your Target Audience
What grade levels does your school have?
Which of the following best describes your school ?
Estimated number of students for target program(s):
Please check off all of the topics that interest you:
Overcoming Adversity		Disability Awareness
Self-esteem Enhancement		Character Development
Conflict Resolution		Peer Pressure
Violence Prevention		Anti-Bullying Strategies
Prevention Programs		Communication Skills
Parent Workshops		Dream Building
Career Days		Keynotes
Yes, I am interested in 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 Bi-monthly speaker presentations on a variety of topics Various programs throughout the year
Have any suggestions or special requests for us? Please describe them below. Feel free to describe the theme or special event related to your desired program(s), if any.
You will be redirected to the homepage upon submiting this form.
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