Tell Us About You!
Step 1) Contact Information
Organization:
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Step 2) Contact Person
Name:
Title:
E-mail:
Telephone:
Step 3) Tell Us About Your Needs
We're interested in: Keynote Presentation Live Workshop (1.5 hrs) Live Workshop (3 hrs) Live Workshop (6 hrs) Corporate Sponsored Youth Training Coaching/Consultation
On the subject of: Businesses Helping Community and Kids (keynote) Stopping at Every Lemonade Stand (keynote) Creating Positive, Connected Schools (keynote) YouthPower! (workshop/seminar) Creating Safe, Caring and Connected Communities for Kids (workshop/seminar) How to Build Healthy Schools and Organizations with Relationships & Research (workshop/seminar)
Our time schedule needs are: for the following date: within a week of this date: within 2-3 weeks of this date: within one month of this date: (we have no definite plans) January February March April May June July August September October November December 01 02 03 04 05 06 07 08 09 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 2018 2019 2020
Thank you for completing this form. James will contact you soon!
Copyright ©2006, James R. Vollbracht. All Rights Reserved.