Welcome To Let's Play Again

I WANNA PLAY WITH DR. PLAY!

	Potential Dates:
	Your Company Name:
	Your Title:
	Your Name:	** required
	Your Email Address:	** required
	Your Phone Number
	Your FAX Number:
	Approx.Budget:
	How many will be attending?
	Is this for a keynote?	Yes No If yes, please describe below.
	Is this for a half day seminar?	Yes No If yes, please describe below.

PLEASE DESCRIBE YOUR EVENT OR APPEARANCE REQUEST (Any information that could be helpful e.g. the type of audience, focus of the event, agenda, etc. would be appreciated)