Organization:
Mailing address of organization:
Host organization website:
Contact name:
Email address:	* required
Telephone:
What is the best way to contact you?	By email By phone
What is your estimated timeframe for the event?	Less than a month 3 months 6 months One year Next year Not sure
What programs are you interested in? (check all that apply)	Adult speaking engagement School assembly Upward event Business training Not sure
How did you find out about Jerry Ackerman?	Email Postcard Seeing him at another event Referral Google search From Upward site Dave Hackett Other
Comments:

All training and speaking engagements through this site are handled through Jerry Ackerman, Jerry Ackerman Productions, or Dave Hackett.  Each engagement must have a signed contract by the organization or contact.