Youth Speaker : Patrick Maurer : Speaker Interest Form

Speaker Interest Form
Please fill out the form to request more information about Patrick's availability and fees and/or to hold or book a date.

Please note that filling out this form is not a binding contract or agreement.
Please fill out all fields -- the more information you provide, the better Patrick will be able to assist your organization
You should receive a response within 10 days of submitting this form

Contact Name: *

Contact Email: *

Organization Name: *

Organization Address: *

Organization Phone (with Area Code): *

Organization Fax (with Area Code):

Interested in: *

Preferred Presentation Date(s): *

Presentation Venue Address: *

Anticipated Audience Size:

Describe Age, Experience, Expectations of your audience:

Goals for this presentation: *

For the purposes of travel research and scheduling, Patrick will be able to depart by:

For the purposes of travel research and scheduling, the 1-3 closest airports are:

How did you hear about Patrick?

Additional Comments

Would you like to be added to Patrick's mailing list? *
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patrick maurer

speaker educator entertainer