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Appearance Request Form

If you are interested in having Chris Soentpiet speak, please fill out the appearance request form:

Name *

First

Last

Email *

Email

Confirm Email

Name of School, Conference, or Library *

Event Address *

address where event will take place

City *

State *

Zip Code *

Event Email *

Email

Confirm Email

Phone # *

Your Position *

Type of Event *

Program *

A: Picturing the World (Chris only)
B: Beyond Written Words (Chris & Yin)
C: Virtual Visit (Chris only)
D: Where Are You From? (Yin only)
Undecided

Number of Presentations *

1
2
3
4
5
Undecided

Audience *

Elementary school
Middle school
High school
Educators/Teachers
Parents/Children
Public library
Public event
College
Others

Event Sponsor

BOCES
School
Conference
PTA/PTO
District
Fundraiser
Title 1 Grant
Local business
Others

How did you hear about Chris? *

Another School/Conference
His Books/Brochure
Internet search
Educator/Teacher
Parent/Student
Book Signing/Public Library
Public Event

Comment or Message

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