Fill the form below and proceed to payment to secure your seat.

NAME

COMPANY NAME

PERSONAL MAILING ADDRESS

City, State, Zip Code

Cell Phone

E-Mail Address

Please list one other than your company address

HOW LONG HAVE YOU ORIGINATED

YOUR LAST YEAR PRODUCTION UNITS/VOLUME

YOUR EXPERIENCE USING MEDIA AND PR

WHAT YOU HOPE TO GET FROM THIS CLOSED DOOR EVENT

WHAT IS YOUR BIGGEST FEAR OR CONCERN ABOUT BEING THE CELEBRITY EXPERT IN YOUR CITY

THE EVENT AND PROGRAM WILL BE A SUCCESS WHEN I CAN

I AM WILLING TO ATTEND THIS CLOSED DOOR 2 DAY EVENT IN BALTIMORE AND SIGN A CONFIDENTIALITY AGREEMENT:
YesNo

Signature

Date