Apply For Representation With AMSB
American Motivational Speakers Bureau^SM

State: Zip:
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Phone:

Cell:

Fax:
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Your E-mail Address:

Your Secondary E-mail Address:

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What is your Fee for a Keynote (up to 60 minutes):
$
What is your Fee for a Half Day (at least 3 hours):
$
What is your Fee for a Full Day (at least 6 hours)
$
What type of Flight Travel do you Require?

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What is the primary Topic that you offer?

What is a secondary Topic that you offer?

What is a third Topic that you offer?

What else should we know about your topic(s) ?


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Do have a Professional Demo Video?

Yes
No

Do you have a Professional Quality One-Sheet?

Yes
No

Do you have a Fee Schedule Sheet?

Yes
No

Do you currently work with Other Speakers Bureaus?

Yes
No

If Yes, list the other Bureaus?
(Include contact persons, addresses, phone numbers & e-mail address.)

List Three Client References:
(Include contact persons, addresses, phone numbers & email address.)

Give Us Three Or Four Sentences That Describe You:
(This may be used in our promotional materials to describe you.)

Is there anything else you want tell us ?