Events Request

Primary Contact Information

Name*

First Last

Title or Job Position

Cell Phone Number

Work Phone Number*

Fax Number

Email*

Event Location Information

Location Name*

Location Website

Location Physical Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Location Mailing Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Location Email Address*

Location Phone Number*

Location Cell Number

Location Contact Name

General Event Information

Type of Event*

Lecture
Workshop
Concert
Private Session

Estimated number of attendees at Event

Have you ever hosted an event for Barry Goldstein before?*

Yes
No

Have you ever hosted an event for another author before?*

Yes
No

If yes, please list the names below:

How many events have you previously hosted?

Do you have any testimonials from participants that attended past events?*

Yes
No

What is the proposed amount Barry Goldstein will be paid for the event? **

Do you currently own a sound system? Please list:

What is the proposed cost for participants to attend this event?*

Are there any products that will be produced from the material received during the event?*

Yes
No

(Media includes: Photographers or videographers.)

Are there any products that will be produced from the material received during the event?

Yes
No

(Please be aware if you answer yes to this question there will be further contracts and negotiations necessary before any event can even be considered.)

What advertising will be done to promote the event?*

What date will advertising begin for this event?*

Please provide a detailed description of the event*

Additional Comments/Information

Primary Contact Information

Company Information

Event Location Information

General Event Information