Contact Name: *

First Name

Last Name

Phone Number: *

(###)

###

####

Event Date Start: *

MM

DD

YYYY

Event Date End: *

MM

DD

YYYY

Event (venue) address:

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Would you be interested in purchasing Albert's books to sell during/after your event?

Yes

No

Will the event cover the cost of Albert’s first-class round trip flight?

Yes

No

Will the event provide a driver to/from the airport, hotel, event location?

Yes

No

If not, will the event reimburse ground transportation expenses for rental car and or Uber/Taxi?

Yes

No

Will the event provide reimbursement for the cost of ground transportation to/from Albert’s local airport?

Yes

No

Will the event cover the cost of hotel accommodations, if needed?

Yes

No

Contact Name *

First Name

Last Name

Contact Phone *

(###)

###

####

Event Date

MM

DD

YYYY

Name *

First Name

Last Name