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NATIONAL Consulting Solutions Inc.
823 W. Park Avenue, Suite 161 Ocean, NJ 07712 (732) 922-4525 or (732) 922-4514
Federal CSI 2042930-03 NJ CSI CC 021770116-791-695 Del CSI - 1738524
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BOOK A SPEAKER OR PRESENTER To book a speaker, please complete the form below and mail, fax, or e-mail it back to us. If you do not hear back from us within 24 hours, please follow up with a telephone call and thank you for Contacting National CSI. Your arrival here was not by accident. Have a continued bless day.
BOOK A SPEAKER FORM Today's Date: ___________________________ First Name: ____________________ Last Name: ___________________________ Position/Title: __________________ Address: _____________________________________ City: ___________________ State: _____________________________________ Zip Code: _______________ Name of Organization _____________________________________________________ Business Telephone No. Area Code __________ _____________________________ Your cell contact No. Area Code: __________ _____________________________ E- Mail Address: __________________________ Preferred Topic: _____________________ _______________ ______________ _________________ ________________ ______________ _______________ Date of your event: _______________________ Length of event: From: ____________________ To: __________________ Your targeted group is: __ Educators __ Law Enforcement __ Attorney's __ Business __ Students __ Nurses __ Social Workers __ Health Care Providers __ Faith Base Organizations __ Other _________________________ __ A little bit of all the above
__________________________ _______________ Please sign and date
NATIONAL CSI SPEAKER REQUEST FORM ORGANIZATION INFORMATION Contact/Title:Organization Name: Address: City: _ State: Zip Code: _____________________________ _______________________________ _ Phone: Fax: Email: __________________________________ _______________________________ Phone number on day of speaking engagement: MEETING INFORMATION Type of Meeting: Date of Speech: Address of meeting location: Time of Speech: Length of Speech: Audience Size: Audience Composition: Meeting Attire : 1 Business 2 Business Casual 3 Casual 4. Outdoor fun in the sun setting
Requested topic: LOGISTICS Recommended Lodging for Speaker Lodging Name: ______________________ ____________________ Lodging address: Lodging phone number: Transportation ________________________________Closest airport name: ___________________________________________________ Recommended ground transportation: National CSI speakers can schedule their own lodging and travel arrangements. If your organization prefers to make any of these arrangements for the speakers, please inform the speaker once he or she is confirmed.
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The requesting organization agrees to pay The National CSI a (to be completed by The National CSI) honorarium. The requesting organization also agrees to reimburse The National CSI for the speaker’s travel, food and lodging expenses. This request may be forwarded to National CSI) based on the topic and length of presentation. All payment is due immediately by the completion of the training day. Approval Signature (to be signed by requester): After completing this form, please fax it to National CSI at (732) 922-4514. Please complete as much information as possible. After we receive the completed form, we will determine if we have a speaker available. Once we secure a speaker for your event, we will contact you to discuss further details, such as honorarium and expense coverage. If you do not here back from us within 24 hours of faxing or mailing in this form, please contact us at the office. Thank you for your interest. We will make every effort to accommodate your request.
Contact Information Please contact us by phone or electronic mail for all your future needs
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