Meeting Planner Inquiry Form

~Speaker Booking Inquiry~

Thank you for taking your time to fill in the following Speaker Booking Pre-Questionnaire. Our office will get back to you to discuss your inquiry further as necessary, by phone or email.

Your name:
Your title/position:
Best phone number to contact you #:
Email:(valid email required)
Company or Group name:
Date of event:
Location of event:
Your title/position related to this event:
Who makes the final decision on the upcoming program?
What is the event? (conference / expo / in-service / convention / retreat, etc):
Website/URL for this group/event/company:
What is the goal or purpose of the event?
Who is the audience? What titles/job positions?
What are the demographics - % Men / % Women?
What do you want the audience to walk away from this presentation saying, feeling, thinking, learning?
What presentation/topic you would like from Kim, or, what is your group focus for this event/program?
Length of program you want from Kim (Keynote 30-50 min; seminar 60 min; one or multiple workshops 1-3 hrs each; retreat - full or more than one day, or explain):
Are there multiple opportunities for which you want to consider Kim? (Kim speaks on several topics and can offer you several seminars, keynotes and/or workshops in the same event.) Please note what kind of events these include:
Speaker budget for this event:
How many will attend event?
How many will attend Kim's presentation?
How will this event be advertised?
Do you need CEU's for this program? Which field? Nurses, Teachers, Therapists, Counselors or name other(s):
Permission for back-of-room sales? (Books, coaching, etc.)
Is there any other information Kim should know about this event? Please include here:
How did you find out about Kim Wolinski/Speaker?
Thank you for your time. You will receive confirmation of this request and feedback within 48 hours.

cforms contact form by delicious:days

Kim Wolinski, MSW…….. “Dr. DeClutter”

$Kim Wolinski \"Dr. DeClutter\"$
Welcome Message from Kim …… click arrow!
Sign up for my "Dr. DeClutter eNewsletter"

For Email Marketing you can trust
~

You’re not here for a long time;
You’re here for a GOOD time.
Are you having one?

Kim brings you content-rich presentations, inspiration with immediate application and lots of humor for the best of all education and training.
Be a Change Agent

The question is not, "What if I die tomorrow?" It is, "What if I live another 20 or 30 years the way I am?"
CHANGE FRUSTRATION TO FREEDOM

....GO FROM CONFUSION TO SOLUTIONS... In these increasingly challenging times, I am dedicated to guiding people through life transitions, change, choices and effective re-decisions — to let go of clutter, distractions, stress, confusion, despair and fear — in every area. Reclaim your balance, peace and joy now.
RECLAIM — RENEW — REFRESH

"The dogmas of the quiet past are inadequate to the stormy present. The occasion is piled high with difficulty, and we must rise with the occasion. As our case is new, so we must think anew and act anew." ~ Abraham Lincoln

Meeting Planner Inquiry Form

~Speaker Booking Inquiry~

Thank you for taking your time to fill in the following Speaker Booking Pre-Questionnaire. Our office will get back to you to discuss your inquiry further as necessary, by phone or email.

Kim Wolinski, MSW…….. “Dr. DeClutter”

Welcome Message from Kim …… click arrow!

~

You’re not here for a long time;

You’re here for a GOOD time.

Are you having one?

Be a Change Agent

CHANGE FRUSTRATION TO FREEDOM

RECLAIM — RENEW — REFRESH