Book Russ Peak

About You
Name*
First Last
Email*
Enter Email Confirm Email
I am a:*
- Corporate Professional
- Educator
- Association Member or Director
- Meeting Planner or Event Committee Member
- College Student or Intern
- High School or Middle School Student
Position / Title
Primary Phone #*
Alt or Cell Phone #
Your Company, School or Organization's Name
Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Website
Anything Else You Want To Tell Me About Your Organization?
Since Your Are A Student... Please Tell Me:
What Is Your Advisor's Name?*
First Last
Your Advisor's Phone Number
Your Advisor's Email
About Your Organization
We are a:*
- Corporation or Professional Association
- Other Association or Non-Profit
- Leadership Camp or Retreat
- Festival, Amusement Park, or Other Public Event
What Type Of Event Is Your Company Hosting?
- Corporate Conference
- Leadership or Staff Training
- Awards Banquet
- Holiday Party
- Sales Meeting
- Trade Show
What Type Of Event Is Your Association or Non Profit Hosting?
- National Association Conference
- State Association Conference
- Regional Association Conference
- Local Association Meeting or Gathering
- Fundraiser Show or Banquet
- Sober Grad Night
What Type Of Presentation Interests You?
- General Session Keynote
- Breakout Session or Workshop
- Conference or Banquet Entertainment
- Conference or Event Emcee
What Type Of Entertainment Interests You?
- Humorous Keynote
- Event Emcee
- Comedy Magic & Mind Reading Show (Entertainment Only)
- Comedy Stage Hypnotist Show (Entertainment Only)
- Not Sure
Have You Or Your Organization Worked With A Hypnotist In The Past?
- Yes
- No
If so, Who?
About Your School Or Organization
We are a:*
- Student Leadership or Youth Organization
- College or University
- High School or Middle School
- Leadership Camp or Retreat
- Grad Night Committee
What Type Of Event Is Your Student Organization Hosting?
- National Youth Conference
- State Youth Conference
- Regional Youth Conference
- School or Local Youth Gathering
- Fundraiser Show or Banquet
- Sober Grad Night
What Type Of Event Is Your School Hosting?
- Assembly Program
- Leadership Conference
- Leadership Training or Retreat
- Career Day
- Sober Grad Night or Lock-In
- Staff In-Service
- Fundraiser or Field Day
What Type Of Event Is Your College or University Hosting?
- Leadership Conference
- Other Educational Conference
- Award Banquet or Holiday Party
- New Student Orientation
- Festival or Other Campus Wide Event
- Student Comedy Night
- Staff Training
What Is The THEME Of Your Sober Grad Night?
What Type of Presentation Interests You?
- General Session Keynote
- Breakout Session or Workshop
- Conference or Banquet Entertainment
- Conference or Event Emcee
What Type Of Assembly Program?
- General High School Motivation (Anything Is Possible!)
- Freshman Orientation
- Positive Choices About Drugs & Alcohol
- Anti Bullying Assembly
- Academic Achievement
- Student Reward Assembly
- Senior Entertainment Assembly
- Comedy Mind Reading or Hypnotist Assembly
Estimated Number of Assemblies
- One
- Two
- Three
- Four
What Type Of Student or Youth Entertainment Interests You?
- Humorous Keynote
- Conference or Event Emcee
- Comedy Magic & Mind Reading Show
- Comedy Stage Hypnosis Show
- Not Sure
Have You Worked With A Hypnotist In The Past?
- Yes
- No
If so, Who?
Okay, What Sort of Entertainment Did You Have Last Time?
Tell Me About Your Event
What Is The Name Of Your Conference or Event?
Do You Have A Date For Your Event?*
- Yes
- No
GREAT! What is the date?
Event City
Event Location
Estimated Size Of Audience
Please enter a value greater than or equal to 10.
Expected Audience Age Range
Budget Range
Please enter a value greater than or equal to 0.
Are There Other Professional Speakers or Entertainers On The Program?
- Yes
- No
Who?
Have You Worked With Any Other Professional Speakers or Entertainers In The Past?
- Yes
- No
Who?
Is There Anything Else I Should Know About Your Upcoming Event?
How Did Your Hear About Russ Peak?
How Did You Hear About Russ Peak?
- Online Search
- Received Mailling
- Saw at Conference or Meeting
- Saw at Camp or Retreat
- I Am A Past Client of Russ
- Referred By A Friend
What Is The Name Of Your Friend?
First Last
At Which Conference or Meeting Did You See Russ?
At Which Camp or Retreat Did You See Russ?
Past Client - Welcome Back! Approx. When Did You Last Hire Russ?
MM
DD
YYYY
Additional Options
- Tell Me How I Can Save Money Booking With Other Schools
- Send Me Your Free eBook "How To Set Goals"
- Put Me On Your Mailing List

THANK YOU FOR YOUR INTEREST IN MY SERVICES!

My goal is to make the hiring just as easy and enjoyable for you (the meeting planner) as it will be for your audience!

Please take the time to fill out the following contact form designed to gather all the information we need to quickly design a program for you.

Once submitted, either myself, or my assistant will contact you within 1 business day.

Need immediate assistance?

Call Russ today! (971) 241-3879

Request Russ Peak Booking Information

About You

Since Your Are A Student... Please Tell Me:

About Your Organization

About Your School Or Organization

Tell Me About Your Event

How Did Your Hear About Russ Peak?