1. Please provide the following contact information:

   Name
   Title
   Organization
   Street address
   Address (cont.)
   City
   State/Province
   Zip/Postal code
   Work Phone
   Home Phone
   FAX
   E-mail

2. Event date:

   -- mm/dd/yy
   

3. Event time:

   -- hh:mm:ss am/pm
   

4. Entertainment budget range:

   
   

   [Be sure to consider travel expenses as well as a show fee when you determine your budget.]

5. Event location:

   
   

6. Number of people expected to attend:

   
   

7. Type of program(s) desired:

   Hilarious Hypnosis Stage Show
   Memory Magic Performance
   Memory Improvement Seminar/Workshop
   

   To schedule only a Memory Improvement Seminar/Workshop,  go to ACTION SEMINARS, where a separate booking form is provided.

   Dr. Amazing can customize programs for you.  One of his specialties is to present a hypnosis show in the evening for a large corporate party, and on the following morning he will present a memory improvement seminar for an executive group or for a sales group.

   Any additional information or questions you would like to submit:

   
   

    

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