Book Mark - Speaker Form
If you are looking to book Mark Crocker for an event, please take a moment to fill out the following information (to the best of your knowledge).
Email address *
Your Name *
Your answer
Name of your organization *
Your answer
Your Phone number *
Your answer
Speaking
Please provide further details about the event
Potential Date of Speaking Engagement *
MM
/
DD
/
YYYY
Address of Speaking Opportunity (street, city, country) *
Your answer
Topic Requested *
Approx length of time *
What is your #1 intended outcome
Your answer
Attendees
Tell me a little bit more about who will be there
How many people do you expect to attend? *
Your answer
What is the approximate age of your attendees? *
Your answer
Would you welcome outsiders from your group to attend? *
Venue Details
Live Online or Live In-Person *
Please list the venue amenities (for live in-person) *
Required
Are you looking for additional communication? *
Required
approximate start and finish times *
Your answer
Expenses
Expenses are in addition to seminar fees, and include:
- Driving (Cost $0.50 per kilometre)
- Airport parking
- Ferry costs
- Flights
- Per diem ($60 per day)
- Rental car, insurance and fuel
- Hotel
- Travel Insurance (where applicable)
I agree to pay all travel expenses over and above any seminar fees (signature) *
Type your full name to validate as your electronic signature
Your answer
Seminar fees *
While I would love to accept every opportunity to volunteer my time, I am unable to do so as I make my living through providing coaching and training sessions.
Thanks!
Mark Crocker
hit the submit button!
I appreciate your interest in having me communicate with your community. I will soon be in touch.

Thanks so much!

Access my promotional Bio and pics at: http://stmleader.com/bio-mark-crocker/
Read my most controversial blog post here: http://stmleader.com/the-country-of-africa/

Mark Crocker
778 995 5505

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