Please provide the below information, so that a contract can be prepared for your organization.

Contact Name:
Contact Person's Title:
Daytime Telephone:
Evening Telephone:
Cell Phone Number:
E-mail address:
Name of person signing contract:
Title of person signing contract:
Name of Organization:
Organization Address:
City
State / Province	Postal Code:
Organization Telephone number:
Organization Fax number:
Organization Web Site:
Number of Presentations:
Type of Presentation(s):	Character Education Assembly Student Bullying Workshop Keynote Address Family Fun Night Commencement Speaker Classroom Visits Morning Pick-Me-Up Afternoon Send-Me-Off
Presentation Date(s):
Presentation Time(s):
Presentation Address:
City
State / Province	Postal Code:
Contract should be sent to:
E-mail address:
OR
Postal Address:
City
State / Province	Postal Code:
OR
Fax number:
Name of Local Newspaper(s):
Name of Local TV Channel(s):

Please add any additional information here: