Speaker Itinerary

Complete the form below and submit to Partners in Business.
Questions can be answered by calling Amy Sadler at (435) 797-2279 or toll-free (800) 472-9965.
*This form is not for seminar registration.

Please Complete The Following

	Name:
	Title:
	Company Name:	Please use the exact name and company as you want it to appear in the brochure and seminar daybook.
	Address:
	City:	State: ZIP:
	Phone:	Fax:
	E-mail:
	Topic to speak on:
	I will be speaking at the following seminar:

	Travel Most speakers arriving by air choose to have a student host, who has expressed interest in meeting presenters and has volunteered to provide ground transportation free of charge. The drive from Salt Lake City to Logan take s approximately 90 minutes.
		Arrival Date (MM/DD/YY) Arrival Time am pm on Flight #
		Travel from Salt Lake City to Logan: (please check one)
		Student host Provide own transportation
		Arrival Date in Logan (MM/DD/YY) Arrival Time in Logan am pm
		Departure Date (MM/DD/YY) Departure Time am pm on Flight #

	Accommodations Partners in Business will provide complimentary accommodations at the University Inn located on campus. We will make the arrangements after we receive this form. The phone number for the University Inn is 1-800-231-5634.

		Yes, I would like to stay at the University Inn
		Arrival Date (MM/DD/YY)
		Arrival Time am pm
		No, I will make my own arrangements.


	Dinners Partners in Business will provide dinner at a local restaurant during the seminar. This is a great chance for speakers to meet the other presenters and the Partners in Business staff.

		Yes, I will be attending the following dinners:
		Tuesday, Dinner Date at 6:30 p.m.
		Wednesday, Dinner Date at 6:30 p.m.
		No, I will not be attending any of the dinners.

	Class Visits If time and schedules permit, presenters may visit business classes or student groups.

		Yes, I am interested in visiting classes on campus
		No, I am not interested.

	Audio-Visual (A/V) Equipment Needs A screen, podium, and corded microphone will be automatically provided

		Please check the items you need.
		35mm Slide Projector with Remote Control
		Transparency Projector
		Wireless Microphone
		Flip Chart
		TV with VCR (VCR holds ½ inch tape)
		Laptop Computer
		Providing my own Model
		Please provide one for me with the following software installed:
		Other

	Release for Tape Recording and Duplication Partners in Business makes available recordings of presentations to seminar attendees. If you do not wish to have your presentation recorded, please indicate.

		Yes, I give my consent to have my presentation recorded and sold by the Partners in Business
		No, I do not want my presentation recorded.

	Speaker Information Release Partners in Business normally keeps speaker information confidential. If you would prefer, we will make your contact information available to seminar attendees.

		Yes, please include the following in the seminar daybook.
		Address & Phone
		Fax & E-mail
		No, I would like my information to remain confidential.

		If you have any questions or concerns, We would love to hear from you. Partners in Business College of Business Utah State University 3520 Old Main Hill Logan, UT 84322-3520 Phone: (800) 472-9965 FAX: (435) 797-3440

	Seminar Speaker Deadlines
		In order for production deadlines to be met, we need the following seminar materials from you in our office by the the following deadlines.

By submitting this form, I agree to speak at the aforementioned conference on the date indicated. If unable to attend I will find someone to take my place as a speaker at the seminar and give PIB at least 60 days notice.