To assist Steve in planning his travel, it is imperative that you complete this brief questionnaire and submit it as soon as possible. Each field is extremely important to ensuring Steve arrives on time and understands the agenda. Try not to leave any field blank.

Steve Gilliland
Northpointe Technology Center II
187 Northpointe Boulevard, Suite 118, Freeport, PA 16229
866-445-5452 | 724-540-5116 fax

    Event

    Date of Event

    Event Reason

    Organization’s Social Media Information

    Client

    Where did you hear about Steve

    PRESENTATION

    Presentation Type
    KeynoteBreakoutEmceePanel Moderator
    Speaking Time(s)
    [time PresentationSpeakingTime class:input-text time-format:HH:mm]
    Room

    Audience Size

    Presentation Topic
    Enjoy The RideMaking A DifferenceHide Your GoatLeading With HeartLeveraging the Challenges of ChangeThe Value of Us
    A / V Check Time
    [time PresentationAVCheckTime class:input-text time-format:HH:mm]
    Program Length

    Person Introducing Steve

    venue

    Location

    City

    Zip / Postal Code

    Fax

    Address

    State

    Phone

    CONTACT INFORMATION

    Primary Contact

    Office Phone

    Fax

    Address

    State

    Title

    Mobile Phone

    Email

    City

    Zip / Postal Code

    GROUND TRANSPORTATION

    A professional car service or taxi to and from airport/hotel/meeting site is to be provided whenever possible. If you would like Steve to rent a car, please check the appropriate box. Steve's office will make the reservation.

    Please have Steve arrange his own ground transportationWe will arrange for Steve to be picked up/returned to the airportPlease have Steve take a taxi
    Car Service Name

    Driver’s Mobile Phone

    Nearest Airport

    Driver’s Name

    Confirmation

    Pickup Location

    Miles from Airport to Venue

    HOTEL INFORMATION

    Hotel accommodations are to be made by client and directly billed to client whenever possible. A King, Non-Smoking room should be reserved under Steve’s name. If you would like Steve to make his own reservation, please check the appropriate box. Steve’s office will make the reservation.

    Please have Steve make his own reservationWe will arrange for Steve's hotel

    Check-in

    Hotel

    Confirmation

    Fax

    Check-out

    Address

    Phone

    City

    payment

    Accounts Payable Contact*

    Address

    City

    Zip / Postal Code

    Phone

    Fax

    State