Speaker Application

"Quality Enrichment Programs for the Cruise Industry"
Phone: 305-931-1026 - Fax: 305-931-1132 - Email: Zammel@aol.com

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SPEAKER APPLICATION FORM

(Instead of Submitting this form now, you may print out this page, fill in the form and Fax it to: 1-305-931-1132)

Please Email us a recent photo.

Please provide the following information:

Name (as it appears on passport)

Passport #/Expiration Date/Date of Birth

Companion's name (as it appears on passport)

Companion Passport#/Exp.Date/Date of Birth

Subject

Street Address

City

State/Province

Zip/Postal Code

Country

Work Phone

Home Phone

Cell Phone

FAX

E-mail

Select any of the following specialty areas:

Arts & Crafts      Art Appreciation   Astronomy          Caricaturist    
Clergy             Computers          Destination        Drawing/Sketching       
Earth Science      Fashion            Feng Shui          Financial       
Genealogy          Geology            Handwriting        Stress Management          
History            Interior Design    Legal              Medical         
Marine Biology     Maritime History   Memory             Naturalist      
Nutrition          Oceanography       Opera Appreciation Photography     
Psychology         Self Improvement   Watercolors        World Affairs   
B'Way Appreciation Meteorology        Music Appreciation Movie/Film Critic
Book Reviewer      Antiques/CollectingGolf Clinics       Creative Writing
Image Make-Overs   Gardening          Chocolate Rating   Pet Health Care
Party Planning     Home & Office Org  Identity Theft     Bi-Lingual Destination
Other

If you are applying for more than one topic, please list 4 lecture titles for each:

Please provide a short biography on why you are qualified to lecture:

Please provide any other information you wish to tell us:

SPEAKER APPLICATION FORM

Please provide the following information:

Revised: 07/22/08