Booking Request

How did you hear about Derek Edwards? (Space to write 120 characters)
Name:
Organization:
Office Phone + ext #:
Cell Phone:
Which number is best to call you at and at what time? (Space for 60 characters)
Email:
Tell us about your event that you would like to have Derek entertain at:
Date:
Venue:
City:
Type of engagement: (Space for 60 characters)