Sender's Contact Information:

First & Last Name	*
Phone #	*
E-mail	*

Company/Association/Organization Contact Information:

Name of Company	*
Street Address
Address (cont.)
City	*
State/Province	*
Zip/Postal Code
Country	*

Are You Currently Planning/Organizing an Event?
(Click inside box, to indicate.)
Yes       No

If YES how soon do you anticipate confirming the event program?

Paul Anthony's Hypnosis Show:

For Paul's Show what is your anticipated audience size?
More than 100 people       Fewer than 100 people      Fewer than 40 people

What Entertainers or Shows have you had in the past 2-3 years?

Event Details & Info:

Date(s) of Event(s):	*
Name of Host Venue:	*
Address of Host Venue:
City, Province/State & Country of Host Venue:	*
Zip/Postal Code of Host Venue:

Are you currently working with an A-V (audio visual) company? *
Yes (We'd prefer to implement Paul's technical requirements but at your direction.)
No   (We would like you to quote on fulfilling his technical requirements.)

Name of A-V Company if Yes checked

What is the maximum budget for your Entertainment Program? *
(If Paul Anthony is not available for your date, we may be able to offer other suitable alternatives.) 

Do you already have budget approval?
Yes   No not yet.  Need an accurate quote for budgetary purposes.

Preferred Method of Contact:
Please phone me a.s.a.p. to discuss further.
E-mail

Please indicate how were you referred to this web site?
(ie. Google, Yahoo, Internet Search Engine, Link from another web site, BizBash, TSE Events, etc.)

Any additional comments or important information regarding your upcoming event?
(Please click inside box below and begin typing.)

          Paul Anthony is based in southern Ontario (Canada)