MAIN INFO REQUEST FORM

THANK YOU FOR YOUR INTEREST IN THE SERVICES OF RUSS PEAK!

At Russ Peak Presentations, we strive to make hiring Russ Peak an easy and memorable experience for you (the event planner) as well as the audience. Please take the time to fill aout the following contact form designed to gather all the information we need to quickly design a program for you.

Once submitted, a program coordinator will contact you within 24 hours.

For immediate assistance, call us toll free 800.381.5858

or contact Russ direct on his cell phone 971.241.3879. Thanks!!

YOUR CONTACT INFORMATION:

First Name:

Last Name:

Your Organization:

Street 1:

Street 2:

City:

State:

ZIP Code:

Email:

Phone Number

Alt Phone:

Best Way To Reach You:

Work #

Cell / Alt #

E-Mail

Best Time To Reach You:

ABOUT YOUR EVENT:

Date Of Your Event:

Or...

No date yet

Event City:

Event Location:

Type of Event:

Type of Presentation:

Number of Attendees Expected:

Estimated # of Assemblies or Sessions (Up to 4 assemblies per day max.)

Budget Range:

I would like to learn how I can save money sharing the day with another school:

Yes, tell me more!

No thanks!

Please Enter Any Further Information About Your Event:

Have You Worked With Other Speakers In The Past:

Yes

No

If yes - who:

PRIVACY: "I'm sure you hate spam. So do I! Your information will never be sold or used except throught your requested information request. You have my word. In fact, to prevent spam you will receive an e-mail to CONFIRM your request. Please click the confirmation link in the email when it arrives. Thanks!" - Russ Peak