Presenter Questionnaire

In order to ensure that your needs are met during your time with us, please complete the following information. We will make every effort to accommodate your needs. We appreciate your commitment to this cause. Please submit this form no later than September 30th.

About You

About Your Session

Breakout Session Title *

Breakout Session Synopsis *

What supplies will you need for your session? *

LCD Projector & Screen DVD/Blu-Ray Player & TV CD Player Dry Erase Board, Marker, Eraser Flip Chart, Marker, Easel Materials to Be Printed in Program (I will submit by September 30th) I Do Not Need Supplies

Would you like Vendor Space to sell your books, DVDs, or other materials throughout the weekend? *

Yes No

Your Preferences

Before presenting, I would like: *

Friday Night Dinner *

While presenting, I would like: *

Saturday Afternoon Lunch *

After presenting, I would like: *

Please specify any food allergies you may have here: *

We understand that some service providers are unable to accept "gifts of appreciation" in return for their participation in certain events. Are you able to accept gifts of appreciation for your presentation? *

No, I am unable to receive any gifts or services for my presentation. Yes, I am able to receive a gift of appreciation for my presentation.

Holistic Hurt, Wholistic Healing Presenter Questionnaire

About You

About Your Session

Your Preferences