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Karel Murray, DREI
Our Branch, Inc.
2731 Ragley Drive
Waterloo, IA 50701

E-Mail: karel@karel.com

Toll Free: 866.817.2986
Office: 319.296.9379
Mobile: 319.239.1464
Fax: 319.296.9380
Reduced Fee Application Form

This form is for those organizations who would like to submit their name for consideration of a free or fee reduced speaking engagement with Karel Murray. Please complete this comprehensive application and submit to me by pressing the "Send Information" button located at the end. You may also print out the form (legal size), complete it and fax it to (319) 296-9380.

My corporate policy with on-line visitors is to strictly honor your Internet privacy. Thank you for providing the information requested. I will honor complete confidentiality and agree not to give, sell, or trade your data. I'll contact you upon receipt of your application to confirm the information and review options.

Thank you!

Organization Name
Contact Person Name
Contact Address
Phone Number ext
Fax Number
E-Mail Address


Conference Purpose & Theme
Conference Theme
Purpose of the meeting
What are your specific objectives for Karel’s presentation?
Select from the list below the things you expect from Karel's presentation: Motivation
Training
Reinforcement of organization goals
Increased enthusiasm
Increased accountability for success
Better communication
What acronyms or industry words apply to your organization?
What trends are affecting your organization and will impact your future?
What issues should be avoided, if any?
What changes in attitude and performance do you expect to see as a result of Karel’s presentation?
What other speakers will be on the agenda?

Audience
Number attending
Spouses included? Yes No
Gender percentage Male %  Female %
Age range to

Presentation Specifics
Presentation Date(s)
Presentation Start Time
Presentation End Time
Introducer’s Name
Introducer’s Title
What is the attire at the presentation?
What takes place (break, meal, cocktail hour)
    Immediately before Karel's presentation?
    Immediately after Karel's presentation?
What program you are interested in?
Are you interested in providing a copy of Karel's book to your audience? Yes No
Are you interested in videotaping or recording Karel's presentation? Yes No
Will the video or cassette be sold to audience members? Yes No

Travel & Accommodation Information

What is the exact location of the meeting?
   Meeting Facility
   Room Number
   Mailing Address
   Phone Number
   Key Contact Person
How far is it from the airport to the meeting site?
Will you be making hotel accommodations? Yes No

Where will Karel be staying?
   Hotel Name
   Address
   Phone Number
   Distance To Meeting Facility


Please guarantee these reservations for late arrival on your master account if your organization will be paying for hotel accommodations.
Will you be making travel (flight) arrangements for Karel? Yes No
When would you like for Karel to arrive?
When would you like for Karel to depart?
Will you be picking Karel up at the airport? Yes No

Who is the emergency contact if problems occur while traveling?
   Name
   On-site Phone
   Home Phone
   Cell Phone

What is the primary product or service you provide?
What are your strengths compared to the competition?


Please include with the survey if available:

  • Black & white logo clip art
  • Annual report
  • A rough or final agenda of the meeting
MPI NSA
REEA
"Karel shows us ourselves in a new way. It's enlightening!"
Mark Pittman, Amazing Enterprises