Organization: ______________________________________________________________________

Address: __________________________________________________________________________

City____________________________________ State_____ Zip_______

Phone:_____________________________________ Fax:__________________________________

Contact Person:______________________________ Phone:_______________________________

Title: _____________________________________________________________________________

THE EVENT

Speaker: ______________________

Title of Presentation:  ________________________________________

Theme of Meeting:__________________________________________________________________

Date: _____________________Number of attendees:__________

Audience profile:____________________________________________________________________

Venue:____________________________________________________________________________

Program start:_______________ Finish________________: Breaks:___________________

Special Requirements of Speaker: LCD projector with wireless remote, screen, small table at front for speaker’s materials.

Other Requirements: _________________________________________________________________

PROGRAM FEES
AND EXPENSES

Program Fee: ____________________________________________________________(plus expenses)

Deposit: US$(50% of program fee to be paid upon confirmation of booking. Balance of fee to be paid to speaker at event prior to presentation. Check payable to:

 Rounds, Miller and Associates  - EIN 113679330.

Round trip airfare full coach: US$_____________________ (speaker to provide client with locator#)______________

From: __________________________________ To ______________________________________

Ground Transportation: Includes taxi cabs or car rental to and from event.

Hotel Accommodations: Includes meals & gratuities (Billed direct to client).

Number of nights:__________________________ Number of persons:________________________

From (date)_______________________________ To (date)________________________________

Handouts and support materials: Client to order materials 4 weeks prior to event. Quantities greater than 250 sets will be invoiced to client after completion of program.

ACCOMMODATIONS
& TRANSPORTATION

Hotel: _____________________________________________________________________________

Address: ___________________________________________________________________________

City______________________________________ State_________________ Zip______________

Phone:___________________________________ Fax:_____________________________________

Contact Person:____________________________ Title:____________________________________

Airport to arrive at: __________________________________________________________________

Arrival date _________________________________Arrival time:___________________________

Transportation from airport to hotel:

Contact Person____________________________: Phone__________________________________

Speaker agrees to abide by the ethics of the National Speakers Association at all times.

Speaker: _______________                          Client: __________________________________________

Date: ______________________________________ Date: __________________________________