Name of Organization*Organization's Website Your Name* First Last Email* PhoneDate of Event* Tentative Time of Event* : HH MM AM PM Location of Event* City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Expected Number of Attendees*Purpose/Goal of Event (Client Appreciation, Boost Sales, Etc.)*Which programs are you interested in?* Humor in the Workplace Innovation and Creativity Customer Service / Teamwork Entertainment Only Host and Emcee Desired program length:*Speakers/Entertainers who have worked well for your past events:Will Devin be allowed to sell his book and DVDs following the presentation?* Yes! No, thanks! You can check out all of Devin's products on the product page.How did you hear about Devin Henderson? Check all that apply.* Word of Mouth Referral Online Search Social Media (Facebook, Twitter, YouTube, LinkedIn, Etc.) KC Improv Email Newsletter Saw Devin at Another Event Local Morning Show Other Please describe:Please tell us who referred you.Additional Comments:NameThis field is for validation purposes and should be left unchanged. This iframe contains the logic required to handle AJAX powered Gravity Forms.