Speaking Request Form

To inquire about having Jim Prevor speak to your organization, please use the following form:

Jim Prevor Speaking | Cornell/United Fresh Executive Development Program

Proposed Date:
Proposed Time:
Proposed Travel Dates:	departure from South Florida
	return to South Florida
	Generally departs from South Florida: West Palm Beach, Fort Lauderdale, Miami or Boca Raton Airports. Sometimes Jim's travel schedule dictates other points of departure. Generally Jim flies first class and requires a hotel room with high speed Internet access.
Nature of Presentation:
please select all that apply	Opening Keynote Closing Keynote Breakfast Speaker Luncheon Speaker Dinner Speaker After Dinner Speaker Present a Workshop Moderate a Panel Participate in a Panel Other, please explain:
Topic of Presentation:	We would like Jim to address the subject of ...
	Jim can use a presentation he has given elsewhere. Jim can use a presentation he has given previously, but not one presented at . We would like a presentation specifically for our event.
Estimated audience size:
Nature of the audience:	please describe attendees' job categories, male/female ratio and other relevant information ...
Audio/Visual Requiremens & Handouts:	What would you like Jim to bring? Nothing - AV & Handouts would be inappropriate. Major AV - video, music, multi-screen presentation, etc. A nice PowerPoint with appropriate photos & illustrations. A simple, all-text PowerPoint. Use on-site overhead projectors or easels with paper/markers. Handouts to enhance take home value.
Is the organization sponsoring this event a 501(C)3 (charitable) organization?
What is the venue for the presentation?
City, State, or Province of the venue:
Country of the venue:
Proposed compensation or honorarium:
Coordination:	Who is the individual we should work with regarding arranging for this presentation?
	Name: Organization: E-Mail: Telephone: Fax: Address: City, State, or Province: Country: Zip or postal code:
Additional Comments:	Please feel free to tell us anything we should know about your organization, this occasion, etc.