A.J. "Keepin It Real" Johnson
Building Communities and Saving Lives
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OUR SPEAKER
PROGRAM REGISTRATION FORM
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HOME PAGE
PROJECT P.L.A.N.T.
PROGRAMS
OUR SPEAKER
PROGRAM REGISTRATION FORM
WHERE'S A.J.
BRASS SOUNDS/SERVICES
BRASS MASS MEDIA
DONATIONS
PAY IT FORWARD LA
PLACES WE HAVE BEEN
BULLY BANDITS
MANAGING TIME
B.A.R.T.
MATRIMONY AND ME
BRASS Sounds & Services
(Schedule Your Event Below)
Please fill out the following Activity Request Form for your upcoming event:
The field marked with (*) are required fields.
*
Name:
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Address:
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City:
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State:
[Select One]
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Other
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Contact Person:
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Title of Contact:
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Day Phone:
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Night Phone:
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Email Address:
*
Address of Location for Activity:
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Title of Event:
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Describe Program Focus, Purpose and/or Nature (What would you like to see happen at your program?):
*
Please check all items that you would like to have at your event:
Sound System $100.00
Technician $50.00 Per Hour
Mic with Stand $25.00
Speaker with Stand $50.00
CD/Cassette Player $25.00
Bullhorn $25.00
LCD Projector/Infocus Machine $50.00
Projector Screen $25.00
Overhead Projector $25.00
VCR $25.00
Laptop Computer $50.00
Table $25.00
Small TV/VCR $25.00
Large TV/VCR/DVD $50.00
Tent $25.00
Digital Camera $25.00
Video Camera $50.00
Camera Stand $25.00
DVD Player $25.00
Generator $75.00
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Type of Audience:
[Select One]
Religious Program
High School Program
College Program
After School Program
Conference
Key Note Address
Professional Inservice
Other
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Date of Event:
*
Time the entire event Begins and Ends (Ex:10:00 am - 1:00 pm):
Comments
WHERE'S A.J.
BRASS SOUNDS/SERVICES
BRASS MASS MEDIA
DONATIONS
PAY IT FORWARD LA