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Name:________________________________________________________________________________________
E-Mail:________________________________________________________________________________________
1.
How did you hear about
CLASS?______________________________________________________________
_______________________________________________________________________________________________
_______________________________________________________________________________________________
2.
What are you expecting from the three
days?_________________________________________________
_______________________________________________________________________________________________
_______________________________________________________________________________________________
_______________________________________________________________________________________________
3.
What are your speaking/writing dreams and
aspirations?_______________________________________
_______________________________________________________________________________________________
_______________________________________________________________________________________________
_______________________________________________________________________________________________
4.
Are you primarily interested in _____Speaking,
_____Writing, or ________Both?
If
speaking, approximately how many speeches have you
given?________________________
Is
your primary market _____Church, _____Corporate, or
_____Other?
Please
indicate market if
other_________________________________________________________________
If
writing, _____Books, _____Magazines, or
_____both?
Are
you published? _____Yes _____No If Yes, Name of
Publishing
House____________________________
If
"Yes", please list the titles of books or magazines
in which you have been
published______________
_______________________________________________________________________________________________
_______________________________________________________________________________________________
_______________________________________________________________________________________________
_______________________________________________________________________________________________
5.
Briefly describe your speaking/teaching experience,
writing experience, relevant education, work, or
volunteer-related experience:
_______________________________________________________________________________________________
_______________________________________________________________________________________________
_______________________________________________________________________________________________
6.
Is there a specific area in which you need
help?________________________________________________
_______________________________________________________________________________________________
_______________________________________________________________________________________________
_______________________________________________________________________________________________
7.
Are you rooming with a friend, family member or
colleague? If so, please give that
person's
name_________________________________________________________________________________________
CLASServices,
Inc. , 2201 San Pedro,
Building 1 Suite 225
Albuquerque, NM 87110
Phone: 800/433-6633, Fax:
505/899-9282
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