Book Dr. Mel Borins

Thank you for your request. A signed Contract Agreement and deposit of 50% of  Speaker Fee, (plus Applicable GST) will confirm participation. Further details and promotional material will be provided with confirmation. Please complete and submit the Event Requirements.

Your Name

Address

City

Province / State

Postal Code

Country

Telephone

Email

Requested Date & Time - Choice 1

Requested Date & Time - Choice 2

Requested Date & Time - Choice 3

Location / Venue

Audience Size / Details

Format

Select a format... Keynote Workshop Seminar Other

If Other, Please Provide Details

Length / Duration

Topic

Fee / Budget

Fee / Budget plus 6% applicable GST

Travel Cost

Travel Cost: Return Economy Airfare from Toronto Pearson International Airport

Per Diem Expenses

Per Diem Expenses - Accommodations and Meals

Please check preferences / availability. Specific to the type of presentation and audience, Dr. Borins will provide further details/requirements upon confirmation.

Set Up

Theatre Style	Round Table
Classroom	Other

Set Up: If Other, please provide details

Equipment

Podium with MIC	Wireless Lavaliere MIC
Handheld MIC	Flip Chart/Markers
Table at front for computer	Power Outlets
LCD Projector	Screen for PPT Presentation
Slide Projector/Screen	2 Microphones (Adjustable Stands)
Stool	Pitcher of Water/Drinking Cup

Please visit our online store to order Articles / Books / Audio CD's. Please complete the text box below for Handout requirement details

Handouts