Click here for a type, print and
mail version - PDF.
Please
send form and payment to:
Gregath Co., PO BOX 505, Wyandotte, OK 74370.
Information provided here will be used for ongoing PR so please send this in with payment ASAP.
Name: ___________________________________________________________________________
Address: _________________________________________________________________________
Phone Number:_______________________________
Preferred Roommate (optional): _____________________________________________________________________________________________
Non-retreat roommate(s), if applicable: ________________________________________________________
Surnames Researching (for sourcebook): ________________________________________________________
Email: ________________________________
Website/Blog: ________________________________
Note any electronic contact information provided may be used online and in PR
Presentation Equipment Requested (podium, digital projector and screen already in room, computer if requested):
_____________________________________________________________________________________________
Comments (include your biographical information for PR):
_____________________________________________________________________________________________
_____________________________________________________________________________________________
_____________________________________________________________________________________________
Speakers cannot provide referral bonuses for others - though they are eligible for unlimited referral bonuses for attendees they refer.
____ Speaker Standard Retreat Package
@ $205.00 = $______________
until September 1, 2016- as available
____ Day Tripper Speaker @ $80.00 - 5 hours (specify day) = $______________
until September 1, 2016 - as available
____ Additional Day Tripper
- 5 hours
@ $100.00 = $______________
until September 1, 2016 - as available
____ "Single" Supplement @ $60.00 = $______________
until September 1, 2016 - as available
____ Additional Nights @ $120.00 ea (GCI pre-approval needed) = $______________
until September 1, 2016 - as available
Enclosed is $_______________: This is full payment or down payment (please circle one)
NO
SHIPPING OR HANDLING FEES NEEDED
Page Last Updated:
December 21, 2017