DR. FF BASCOMBE'S BOOKING FORM
We are happy to assist you in building other's lives. Please provide the following:
Print out, print clearly, and FAX back to us at: 352-455-9298
Or cut and paste into a Word doc. and e-mail from your e-mail to: drbascombe@drffbascombe.org
Today's Date: _____________________________________________________
Organization: ______________________________________________________
Event coordinator:__________________________________________________
Home number: ____________________________________________________
Work number: _____________________________________________________
Cell Number: ______________________________________________________
FAX:____________________________ Need cover sheet? (yes or no)
E-Mail Address: ___________________________________________________
Activities Requested: please circle or check off your needs:
□ Motivational Speaker (A Specific Speech)
□ Minister (From The Book of Life)
□ Perform Music (From her CDs: Conversation With My Overseer; I Can CD; Traditional Xmas
with Flavor); Hymns from Hymn Hop CD; I CanD for Ears CD
□ Hostess
□ Coretta Scott King Living Portrayal
□ CD/Product Signing
□ Youth Connect With Youth Session (Brain-Scanning Towards Personal Empowerment)
□ General Empowerment Workshop (For anyone: Church, Corporate, Organizations or
Private Engagements)
□ NEW!! Guy-Talk Session (Wisdom for Boys/Young Men in Training)
□ NEW!!! Doll-Talk Session (Wisdom for Girls/Young Ladies in Training)
□ NEW! Focus on the Family Session (Wisdom For Parents Or Those Desiring To Be Parents)
□ Pageant/Talent Show Coaching or Judging
□ I Can Ring Party (Any Age)
□ Mellenium 31 Women (19- 50’s yrs.!)
Event Name:
___________________________________________________________________________
Location (name of building, city, state and zip code) and address: ________________________________________________________________________________
DAY and Date of Event: ______________________________ Time: ___________________
Type of audience and expected attendance:_________________________________________________________________
Duration of Speech or Workshop:________________________________________________
Website Address:_____________________________________________________________
Reason for Event:
________________________________________________________________________________
________________________________________________________________________________
________________________________________________________________________________
________________________________________________________________________________
Is it FREE and open to the public?________________________________________________
How much are the tickets or registration fee and who can they contact to get more info?
________________________________________________________________________________
________________________________________________________________________________
What is your speaker 's budget or honorarium? (We go off of what YOUR existing budget is for
the speaker/artist that you requested? This amount should NOT include the speaker’s round trip airfare and hotel room. You must fill in an amount on this requested part.
___________________________________________________________________________
Thank you for your interest and for filling in all the blanks. We will get back to you as soon as
we receive your request. God bless you! Remember to live, laugh, love!!!
To Contact: 352-455-9298