STUDENT ENROLLMENT FORM
COMPANY INFORMATION (If applicable)

COMPANY NAME: ____________________________________________________________________
COMPANY ADDRESS: ________________________________________________________________
CITY: ___________________________STATE: ____________ZIP CODE: _______________________
COMPANY PH.#_______________: COMPANY FAX#:______________ E-MAIL: ___________________

STUDENT INFORMATION

STUDENT’S NAME: ___________________________________________________________________ STUDENT’S ADDRESS: ________________________________________________________________
CITY: STATE: ZIP CODE: _______________________________________________________________ STUDENT’S PH#:____________ CELL PH#:_____________ E-MAIL:_____________________________
COURSE START DATE: ______________________

NAME OF COURSE(S) STUDENT WILL ATTEND: (Check all that apply)

NAMES OF COURSES AND COSTS :

___ 12-Hour Speaker Development Course - $295*
___ 6-Hour How to Become a Confident & Effective Speaker Course - $195*
___ 4-Hour Basic Introductory Speaker Course - $150
___ 2-Hour Seminar on How to Write a Motivational and Persuasive Speech - $100.
___ 2-Hour Seminar on How to Start Your Own Profitable Home-Based Business - $100.

NOTE: At least six people must be registered to attend, before a Course will begin.Weekend Seminars can be arranged upon special request.

AVAILABLE SERVICES AND COSTS :

___ Engagement of Motivational and Business Speakers – (Fees vary).
___ Speech Writing Services (Fees vary).
___ Master or Mistress of Ceremony Services for Any type of Event – (Fees vary).
___ Voice-Over and Narration Services for Audio-Visual Recordings – (Fees vary).
___ Motivational Seminars at Business Facilities to Encourage Personnel Productivity – (Fees vary).
___ Annual USB Membership for Part-Time Speaker Consultants – There is no charge to join. Commissions are received from speaking engagements.
___ Radio & Television Appearances for fund-raising and product commercials – (Fees vary).

*A book on “How to Become a Confident & Effective Speaker” and a recorded narration of the book on CD, will be issued to Students that complete the Course.

ENROLLMENT & PAYMENT INFORMATION

Call USB at (800) 758-4440 to register. Complete this Form and fax it to: (856) 427-9508. All Courses can be paid in advance by mailing a check or money order to: Universal Speakers Bureau – P.O. Box 2133 – Cherry Hill, New Jersey 08034, or bring a check to the Cal-Tech Learning Center for the Course when you attend. Dr. Williams’ Books and CD’s entitled “Instant Inspiration” & “How to Become a Confident and Effective Speaker” can be ordered online from www.confidencebuilderpublications.com.