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Jim Richardson's Program Scheduling Form for Nonprofit Groups

Jim has presented to over 100 organizations.

Businesses and other for-profit groups, please use Jim's Program Request Form for Professional Speaking Engagements

* = Required field
*Name of Program Chair: *Email:
*Name of your group:
*Work phone: *Work fax:
*Home phone: *Cellular phone:
*Average attendance:
Note: need a minimum of 25 "for-sure" attendees for the humor to work effectively.
*Day of week: * Event: *Available calendar dates:
*Name of meeting location building:
*Street address:
*Nearest cross street: *City:
*Special travel directions:
*Name of contact person day-of-event:
Technical information:
Do you provide: — a lectern? yes no — a microphone? yes no — a display table? yes no
Is it okay if I video tape just my portion of the meeting? yes no
Raffle prize:
If you would like to offer a FREE 20 minute coaching session with me as part of your raffle (Value: $70), please check here and I will email you a certificate to present your raffle winner:

Please take one last look at this nonprofit Program Request Form to make sure that you have filled it out completely, then check here to confirm that your request is: correct
Thank you for writing up your request.
To submit this form please:
This program is supported by most major browsers. But, if you haven't received a confirmation e-mail back from me within two days, then please bug me by e-mail at: or phone me at: 415-877-4424, Cellular: 415-505-1381.

You can also print this form, check to make sure that all blanks printed out, and then snail-mail it to Jim at:
Jim Richardson
P. O. Box 992
Mill Valley, CA 94942-0992
©1997-2012, Email:

Topics | History | Promotion | Calendar | Program scheduling form | Home