Booking

Would You Like to Have Steve Speak At Your Office Event, School, University Or For Your Employees? Take The First Step, Complete This Form!

PowerMoves Event Request Form (ERF)

The information you provide here will help us serve you better. Please complete this form and click the submit button at the end.

Engagement Information

Date Form Completed *

Date of Event(s) *

Type of Event(s) *

Location of Event(s) *

Address *

City/state/zip *

Start Times of Event(s) *

End Time of Event(s) *

No. of Sessions *

No. of Attendees *

Duration of Talk *

Approximate ages of Attendees *

Theme/Title of Event *

Contact Person's Name and Title *

First

Last

Work and Cell Numbers *

Fax Number *

Email *

Group Sponsoring Event *

Sponsoring Group's Full Business Address *

Comment *

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Powermoves
P.O. Box 56
Flintstone, Maryland 21530
email Karen Fitzhugh at: Powermovestime@aol.com
Fax: (651) 344-0671

www.PowerMoves.org

PowermovesP.O. Box 56Flintstone, Maryland 21530email Karen Fitzhugh at: Powermovestime@aol.comFax: (651) 344-0671

www.PowerMoves.org

Powermoves
P.O. Box 56
Flintstone, Maryland 21530
email Karen Fitzhugh at: Powermovestime@aol.com
Fax: (651) 344-0671