I.  About Requesting Organization:

Name_____________________________________________________________


Mailing Address_____________________________________________________


Business Phone (_____)________________ Fax (___)______________________


Email___________________________ Website___________________________


How did you hear about us?___________________________________________


_________________________________________________________________


II. About Contact Person:

Name ____________________________________________________________


Cell phone (_____)___________________Email___________________________


III. Method of Payment: Credit Card Type______________________________


Name on Card__________________ Card #________________ Exp. _________


IV. About the Presentation:


Program(s) Requested:________________________________________


​__________________________________________________________


Day & Date & Time Requested_____________________________________________________


Alternate Day-Date-Time:_____________________________________________



Duration of time requested (30, 45, 60 min., etc.) _________________________


Number in audience (approx. OK)_____ Place_________________________ 


Directions:       


SPEAKER KEEPER JAMES RESERVATION FORM

  • Call 252-996-0493;
  • or print and mail to Keeper James, P.O. Box 362, Rodanthe, NC 27968-0362;
  • or scan and email to KeeperJamesLSS@gmail.com.    Thank You!

FEES:


Fee quotes upon request. Fees vary and are based on several factors: type of performance, location, possible travel expenses, etc.​


PLEASE make reservations well in advance.


50% DEPOSIT required.


CANCELLATION POLICY: generous terms. 



SCHEDULING & FEES