Contact

The Peters Group
339 Saint John Street
Orangeburg, SC 29115
803-516-6097 (O)
803-516-6195 (F)
info@stephenpetersgroup.com

Requested Date(s):

Alternate Date(s):

Presentation Time Beginning:

Presentation Time End:

Referred By:

check all that apply:

	Staff Development (Teachers, Administrators, Support)
	Keynote(Opening, Closing, Luncheon, Dinner)
	Gentlemen’s Club
	Ladies Club
	Youth Motivation
	Parental Engagement
	Other

Specific Area of Focus:

Audience:

Estimated # of Attendees:

Location:

Address:

City, State, Zip

Pre-purchase books for event?

If yes, how many?

If no, would you like us to sell
books at event?

Contact Person:

Email:

Phone Number:

Fax Number:

Organization assuming
financial responsibility:

Address:

City, State, Zip:

Phone Number:

Fax Number:

Person Initiating Request:

Date: