Capitol City Speakers Bureau Speaker Information Request Form

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For more information about speakers for your event, please complete the information below and press the "Submit Request" button,or e-mail us at info@capcityspeakers.com. A member of our meeting planning team will contact you shortly! Please Note: Refreshing the page will clear all field entries. In a hurry? Print this form and fax it to us later! Requires the FREE Adobe Reader. Get it here

I am interested in:

Keynote Speaker
After Lunch or Dinner Speaker
One to three hour session
Break-out sessions
Entertainment
One or more training days

Budget per speaker, excluding expenses:

$2,500 - $5,000
$5,001 - $7,500
$7,501 - $10,000
$10,001 - $15,000
$15,001 - $20,000
$20,001 - $40,000
Over $40,000

Topics:

Agriculture
Business
Cancer Survivors
Celebrity
Change
Customer Service
Diversity
Employee Retention
Ethics
Finance/Economy
Future
Generations
Healthcare/Nursing

Humor
Inspiration
Internet/Social Media
Leadership
Marketing
Motivation
Negotiation
Politics
Retail
Sales Skills
Sports
Team Building
Technology

Please send me information on the following speakers:

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Please provide me with:

Biographical Information
Speaking Fees
DVDs
Link to Streaming Video

Please check the availability of:	for a meeting on:
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Time:
Location:
Comments:

Your Name and Information:

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Title:
Organization:
Address:

City:
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Zip:
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