Seminar Registration
  Seminar Information Form
 
  1. Fill out the form below.
  2. Click on the "Send Seminar Information Form" button at the bottom of the page.
Name of Conference, Retreat, or Meetings  
 
Sponsoring Group
 
Contact Person(s)  
 
Phone
Phone  
 
FAX
  FAX 
 
E-mail 
 E-mail
 
Preferred mailing address
 
Location of meetings         
 

Please call our office within the next two weeks
to discuss all of the **(starred) items before you return this sheet.
 
**Meeting dates (fixed or tentative?)
 
**Specific content to be covered
 
**Specific meeting times
 
**Actual speaking time during each meeting
 
Are there other speakers?    Who?
 
**Number of people expected  
 
**Age and background of people attending  
 
May we invite participants to receive our mailings?   Shall we send publicity?
Photos needed for publicity may be download from our website by clicking here.
 
Shall we send you mailing labels for our friends in your area?   How many would you be
interested in?
 
**Honorarium (Please write a specific U.S. dollar amount) $
(The honorarium check should be made out to MIDLIFE DIMENSIONS)
 
**Will the honorarium be given in advance?  The final day of the meetings?
 
**Overnight accommodations will be made at: (Please choose a hotel with room service)
 
Name of hotel    
 
Address of hotel
 
PHONE
 
**Should we set up a book table?  (If yes, we’ll need two 8 foot tables.)
Can you arrange for someone to oversee the sales at the book table?
Will any other bookstore or organization be selling books?
 
Can you supply:     P.A. System     Video Projector (or large screen TV)      VCR
Lapel Microphone     CD Player        Tape Player 
 
MEETINGS MORE THAN 200 MILES AWAY
 
**Will air travel expenses be covered in advance?  Length of time from airport to
meeting place
(Air travel arrangements will be made by the Mid-Life Dimensions office)
(The Travel Expense Check should be made out to Midlife Dimensions)

Who will transport to/from airport?
Recommended Airport for Arrival 
 
Individual's Work Phone Number
Home Number
 
MEETINGS FEWER THAN 200 MILES AWAY
 
What is the mileage from Fullerton?
 
Will you provide a detailed map to the meeting location?
 
Will auto travel expense at $.45 per mile be covered?
 
Special requests that you would like for us to pray for

 
Thank you for carefully filling out this form. It will assist us in making the decision
about confirming this speaking engagement.
 
Name of person filling out this form:
 
Address     
City            State Zip
Phone (Office) Phone (Home)
Fax #   E-Mail
Position or title
 

After this form is returned to our office and you receive a confirmation letter, a cancellation fee of 25% of the honorarium will be assessed on the party who cancels the engagement. The canceling party will also be responsible for any non-refundable airfare costs.