Please complete and return this form at least 8 weeks in advance of the event to:
Gatorade Speakers Network
Fleishman-Hillard
c/o Tracey Bond
875 N. Michigan Ave., Suite 3300
Chicago, IL 60611
Forms can also be faxed to 312/751-8191 or e-mailed to bondt@fleishman.com.
Call Tracey Bond with any questions at 312/751-3527.
Please Print
TODAY’S DATE: ______________
SPEAKERS NETWORK MEMBER:_______________________________________________________
GROUP ORGANIZING EVENT:__________________________________________________________
GROUP CONTACT PERSON/TITLE: ______________________________________________________
CONTACT PERSON’S ADDRESS:________________________________________________________
CITY, STATE, ZIP:_____________________________________________________________________
PHONE:_____________________________________________________________________________
FAX / EMAIL: _________________________________________________________________________
NAME OF CONFERENCE/EVENT:________________________________________________________
LOCATION OF CONFERENCE/EVENT:____________________________________________________
VENUE OF CONFERENCE/EVENT: HOTEL SCHOOL CLUB HOUSE SPORTING ARENA
OTHER: (Please specify)________________________________
ADDRESS OF VENUE: ________________________________________________________________
CITY, STATE, ZIP CODE: _______________________________________________________________
DATE(S) OF CONFERENCE/EVENT: _____________ REGISTRATION FEE $_____________________
SPEAKER’S DATE AND TIME SLOT: _________________
SPEAKER’S CONTACT AT CONFERENCE/EVENT: _________________________________________
CONTACT INFORMATION OF SPEAKER’S CONTACT: ______________________________________
____________________________________________________________________________________
EXPECTED ATTENDANCE:_____________________ LAST YEAR’S ATTENDANCE ______________
*** Please send all information pertaining to event.
WHY IS THIS AN APPROPRIATE WORKSHOP FOR GATORADE TO SPONSOR?________________
AV EQUIPMENT (to be provided on site)
______ Proxima (preferred- speaker will bring own laptop
______ Slide Projector (optional)
______ Screen
______ Podium (optional)
______ Microphone – For Speaker (Lavaliere Mic Preferred)
______ Microphone – For Audience Q&A (depending on audience size 1-2 hand held microphones
with stands)
AUDIENCE COMPOSITION:
____ % Coaches ____% Athletic Trainers ____% Strength Coaches
____ % Sports Doctors ____% Endurance Athletes ____ % Sports Nutritionists
____ % Athletes ____% Parents ____ % Students
____% Others (please specify)___________________________________________________________
TOPICS*:
____ Sports Nutrition: What Works and What Doesn’t for Optimal Performance (preferred)
____ Myths vs. Facts in Sports Nutrition
____ Nutrition, Weight Control & Body Composition
____ Sports Nutrition for the Competitive Edge
____ Nutrition Fundamentals for Performance
____ Fluid Guidelines for Sports Performance
____ Eating on the Road
____ Other (please specify) _________________
* All presentations should include the most current information on fluids and rehydration.
PROJECTED EXPENSES (fill out known expenses, may leave blank if unknown):
TRAVEL $ _______________
METHOD OF TRANSPORTATION (e.g., airline, personal car): _______________________
LODGING $ _______________________ NUMBER OF NIGHTS: ___________________
ESTIMATED ROOM RATE $ _______________
MISC. $ _______ (Please Describe)___________________________________
TOTAL ESTIMATED EXPENSES $ _______________
PLEASE MARK ANY EXPENSES THE CLUB WOULD BE WILLING TO PAY OR SHARE WITH GATORADE.
HOW WILL THE CONFERENCE/EVENT BE PUBLICIZED?
____________________________________________________________________________________
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DESCRIBE RECOGNITION GIVEN TO EVENT SPONSORS (E.G. ADVERTISEMENTS, PROGRAM, SIGNAGE AT EVENT): (please send any materials that apply)
____________________________________________________________________________________
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OTHER COMMENTS:
____________________________________________________________________________________
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