Book Tom Please take a moment to complete and submit the questionnaire below. We suggest you print a copy for your records. A copy will be emailed to the address you provide. If you have any questions or concerns, please contact us or call us at 303-888-0147. We would also like to encourage you to send us your comments after your event. Contact Information Company* Office Phone* Contact Name*(required) Cell Phone Title Email* (required) Fax Address Line 1 Address Line 2 City State Zip Is this person available to discuss the event objectives and keynote content with Tom by phone? Yes No If not, please provide the name and contact information for the appropriate person: Program Information Event Theme & Objective Audience Size Audience Makeup Suggest content to include Sensitive subjects to avoid Event Information Venue Name Venue Address & Phone Number Report to speaking area by What precedes Tom Yagos’ presentation? Name and title of introducer Presentation start time Presentation end time Total presentation time (not including introduction) What follows Tom Yagos' presentation? Will there be a book signing at your event? Yes No Would you like to purchase products for your event? Yes No Please check out our E-store Will you be recording this event? Yes No Is Tom Yagos welcome to bring a guest? Yes No Audio/Video Information A/V Company A/V Specialist's Name Office Phone Cell Phone A/V Contact's Email Date and Time of Sound Check Have you reviewed the A/V requirements? Yes No If yes, do you have any questions or concerns about the A/V Requirements? Yes No If "Yes", please explain your A/V concerns. How many screens will there be? Will it be front or rear projection? Front Rear Name and contact information of on-site liaison Event Coordinator Event Coordinator's contact Company Client contact name Title Address Office Phone Cell Phone Fax Email Ground Transportation Will ground transportation between the airport and the venue be provided? Yes No Name of transportation service Phone Reservation number Meeting place (for example, the baggage claim area) Travel time from airport to hotel Accommodations Hotel name (if different than event venue) Hotel address and phone number Confirmation number Check-in date Check-out date I agree with the terms and conditions
