AUTHOR VISIT REQUEST FORM:

Please fill out the following form which will aid us in arranging a visit from Robert D. San Souci to your event or school. If you prefer to fax the form, please print the form and send it to (415) 552-5038.

Name First : Last:

Mailing address:

City: , State ZIP code -

Business AREA CODE: Phone Number -

Home AREA CODE: Home Phone Number: -

FAX area code: Number: -

E-mail:

Type of organization. Select one:

Name of Organization:

Virtual or In Person: Select one:

Scheduled time requested. Select one:

Focus of visit. Select one:

If possible, please submit three possible dates for your ideal visit (example: May 15, 2001):
First choice:
Second choice:
Third choice:

Nearest city or airport to fly into:

Request for additional information:

A printer ready Author Visit Packet is available, which includes:

You will need to have Adobe Acrobat Reader installed on your computer. The Adobe Acrobat Reader is available for free. If you need to download a free copy of Adobe Acrobat Reader, click on the Adobe logo show here:.

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Please share any comments or suggestions or ask other questions here:

Thank you for your interest in scheduling a visit to your area.

All best wishes to you,

Robert D. San Souci