Leadership • Inspiration • Motivation

Conference/Workshop Booking Form (for event coordinators only)

Basic Information

First name: *

Last name: *

Title: *

Organization: *

E-mail: *

Ensure that your email is valid. You will receive a copy of this form at the address you enter here.

Address:

Address (cont.):

City:

Province/State:

Postal/ZIP Code:

Phone: *

Fax:

How did you hear about us?

Select an option:

Friend/Associate

Mailing

Search Engine

Other

Other (please specify):

Select conference or workshop

Keynotes:

Don't Miss your Next Flight! (Motivational Keynote)

Fly by Vision to Success! (Leadership Keynote)

Fly Higher and Farther in Adverse Conditions! (Motivational Keynote)

Keep your Propellers Running! (Motivational Keynote)

My Impossible Flight (Inspirational Keynote)

Tell us about your event

Event Date: *

Event Location:

Number of Attendees: *

Theme of Event: *

Budget: *

Budget (other):

Additional Comments:

Please take note that your personal information is for the sole purpose of sending you information about services that KOFISMO International offer. Your information will be kept confidential and will not be given, sold or shared with any third parties.
Thank you!