Contract Information Form

Hope’s Voice International Offices
3206 35th Avenue Suite B3
Astoria, NY 11106
800.516.7680 - phone
info@hopesvoice.org

PART I: SPEAKER SELECTION
Name:*
School/ Company Name:*
Phone:*
Email:*
Please list your top 5 speaker(s) / trainer(s). We will send out availability requests for the event date to the speaker(s) / trainer(s) you have selected. You will receive a price quote and the list of the available speaker(s) / trainer(s) for your event one week after the completed form is received by Hopeís Voice International.
Select at least 3*
Chelsea Gulden  Christina Rock  David Crobitt  Duane Quntant  Jeremiah Vilpando  Josh Lunior  Kevin Fletcher  Lance Smith  Nate Longtin  Nina Martinez  Shelton Jackson  Tim Avant  Todd Murray
Number of speaker(s) / trainer(s) you wish to have attend your program:			Choose one 1 2 3 4 5
PART II: TRAVEL
Thank you for choosing Hopeís Voice International. Please complete the following form so we can book travel arrangements for your speaker(s) / trainer(s). If you are a school please fax or e-mail us a campus map.
Date of Event:* Month: Choose one January February March April May June July August September October November December Day Choose one 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 Year Choose one 2008 2009 2010
Time of Event:*    01 02 03 04 05 06 07 08 09 10 11 12 : 00 15 30 45 AM PM
Requested Speaker(s) / Trainer(s) Arrival Time (sound check, meal, misc.):    01 02 03 04 05 06 07 08 09 10 11 12 : 00 15 30 45 AM PM
Nearest Major Airport:*
Distance from Airport (best estimate):*		miles
Nearest Major Hotel:*
Recommended Taxi/Car or Shuttle Service:
Will a representative from your organization be meeting the speaker(s) / trainer(s) at the airport?*
Yes      No
If yes, please provide the contact information of the representative meeting the speaker(s) / trainer(s) at the airport.
Name:
Phone:
Email:
Address of the event (include any building names or room numbers):
Address:*
Address 2:
City:*
State:*
Zip:*
Notes:
PART III: PROMOTIONAL KIT
KIT 1 1 - Road to Hope Tour DVD ($12.00 retail value) 5 - Does HIV Look Like Me? T-Shirt ($8.00 retail value) 10 - Does HIV Look Like Me? Poster ($30.00 retail value) Cost: Complimentary
KIT 2 – 15% DISCOUNT 1 - Road to Hope Tour DVD 10 - Does HIV Look Like Me? T-Shirt 30 - Does HIV Look Like Me? Poster Cost: $150.00
KIT 3 – 25% DISCOUNT 1 - Road to hope Tour DVD 15 - Does HIV Look Me Me? T-Shirt 40 - Does HIV Look Like Me? Poster 1 - Does HIV Look Like Me? 12 Disc Mini Series ($150 retail value) Cost: $300.00
To order individual items please contact Hopeís Voice International for an order form and custom quote; keep in mind promotion kit packages offer a discount. Take a moment to view the glossy and eye-catching multi-media and print materials from the Emmy-award winning Does HIV Look Like Me? international campaign.