	Speaker Request Form Cal Stevens, President, TACADA Marketing Consultants, LLC Telephone: (404) 289-8536 FAX: (404) 288-3604 E-Mail: president@tacadamarketing.com www.tacacamarketing.com Name: ___________________________ Title: ____________________________ Company:___________________________ Mailing Address: _____________________ City: ____________ State: ______ Zip: ______ Telephone Number: ( ______ ) _______-_________ Your E-Mail address: ____________________________________ *Your address will never be rented or sold anytime, period.* Date(s) of proposed event: ___________________________________ Type of event: ---- Please select one ---- Conference Meeting Weekend Retreat No event decided yet Session at the office Type of session you would like Cal Stevens to do: ---- Please select one ---- Keynote address (45 mins) Keynote address (60 mins) Keynote address (90 mins) Half-day workshop Full-day workshop Multiple day training Theme or name of event (if already determined): ______________________ Location of the event: __________________________ City: _______________ State: _____ Zip: ___________ Size of audience: __________ Estimated Budget: _________ Comments:

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Thank you for the opportunity to contribute to your success!

TACADA Marketing

2765 DaVinci Crescent

Atlanta, GA 30034-3122

FAX: 404-288-3604

PHONE: 404-289-8536

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Thanks for your order. Best Wishes and To God Be the Glory!