TheWealthyDentist.com™ Dental Speaker’s Agreement Request

    To request a speaker's agreement, please complete the following form:

    Select a Minimum of One Topic Area

    Topic Category #1 (required):

    Topic Category #2:

    Primary Contact Information

    Organization's Name (required)

    First Name (required)

    Last Name (required)

    Title (required):
    Dr.Mr.Mrs.Ms.

    Designation (required):
    D.D.S.D.M.DOther

    Your Position in the Organization (required)

    Direct Access Phone # (required)
      Ext:

    Primary Email Address (required)

    Primary Office Contact Information

    Address Line #1 (required)

    Address Line #2

    Address Line #3

    City (required)

    State or Province (required)

    Postal Code (required)

    Country (required):
    USACanadaMexicoAustraliaNew ZealandGreat BritainOther

    Phone # (required)

    Fax #

    Web Site Address
    (www.mywebsite.com)

    Fee Schedule

    Jim has two fee schedules - based on your organization's attitude about speakers promoting their products from the stage. Please select the one that best meets your needs:

    1. For organizations who frown, disapprove of, or discourage speakers from promoting their services or products from the stage, Jim's rate is $10,225 a day.

    2. For organizations that will allow speakers to promote their services and products in a tasteful, non-confrontational and mannerly way, the fee is $4,500 a day. This includes a sales table in the back of the room where doctors can view samples and place orders.

    1.2.

    Meeting Information

    # of Dentists Expected at Jim's Speaking Session (required)

    # of Sessions (required)

    Meeting's Location (required)

    A Description of Your Organization's Purpose (required)

    Comments

    Please type these characters into the box.
    To use CAPTCHA, you need Really Simple CAPTCHA plugin installed.

    © 2018 The Wealthy Dentist ® - Dental Marketing - All Rights Reserved - Dental Website Marketing Site Map

    TheWealthyDentist.com ® - Contact by email - Privacy Policy

    P.O. Box 1220, Tiburon, CA 94920

    The material on this website is offered in conjunction with MasterPlan Alliance.

    All rights reserved. If you would like to use material from this site, our reports, articles, training programs
    or tutorials for use in any printed or electronic media, please ask permission first by email.