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Requesting School District/Organization *

Primary Contact (Name, Email and Best Contact #) *

How did you learn about our company/services? *

Service Date (ATTENTION: if this request is for multiple dates, please clarify/note this info. in the "MISC." section provided at the end of this form.) *

Service Request- Check all that apply. *Keynote/General Session (i.e. during conferences, state-level SNA events, etc.)Breakout Session(s) (i.e. during conferences, state-level SNA events, etc.)District-Level Course(s) (i.e. for school districts)Other

Please use this section to list the projected number of attendees/participants expected (for EACH service requested above). *

Session Length(s) & Quantity: Please provide the # of hours for each service (noted above) separately. (Ex. 45 min. Keynote Address; Two qty. 1.5 hr. Breakout Sessions) *

Audience (ATTENTION: If this request is for multiple courses and audiences, please clarify/note this info. in the "MISC." section provided at the end of this form.) Check all that apply. *DirectorsDistrict LeadersSchool-Based Cafeteria Managers, Assistant Managers and/or LeadsLeaders, all levelsFNS Staff (NON MANAGEMENT), all levels/categories; mixed school based group (i.e. frontline employees, managers, leads, dishwashers, cashiers, etc.)ALL LEVELS (Leaders/Management & School Based Staff of all levels)Other

Requested Session Topics-Check all that apply.(ATTENTION: Please use the "MISC." section below to further note/clarify the audience for each.) *Keynote: 'Keep Moving, There's Light at the End of Your Tunnel!'Keynote: 'What’s Your “Why?'Breakout/District Course: 'Conquering the K-12 Foodservice Market' (MARKETING)Breakout/District Course: 'Engaging Student Consumers' (CUSTOMER SERVICE)Breakout/District Course: 'Empowered to Lead' (LEADERSHIP)Other

Venue Details (What type of room will the services take place in?) Check all that apply. *Keynote: AuditoriumKeynote: Hotel Ballroom (w/ tables)Keynote: Hotel Ballroom (w/ chairs in rows)Breakout/District Course: Hotel Ballroom (w/ tables)Breakout/District Course: Hotel Ballroom (w/ chairs in rows)Breakout/District Course: School CafeteriaBreakout/District Course: School AuditoriumBreakout/District Course: School ClassroomOther

Presenter Resources (Please note all items provided by Your School District/Organization) for all services/sessions/courses. Check all that apply. *LCD Projector (REQUIRED)Audio Capabilities: Basic Microphone (REQUIRED for Keynotes; HIGHLY RECOMMENDED for large rooms)Audio Capabilities: Wireless Lapel Microphone (HIGHLY RECOMMENDED/PREFERRED for Keynotes)Speakers to Project Sound (REQUIRED)Computer (PC/Laptop)Other

Please specify the city/state in which these services will take place. *

"MISC." & SPECIAL/ADDITIONAL REQUESTS---Please use this section to provide any additional information we may need to provide you with a service proposal/price quote. *