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If you would like to receive booking information, please submit the following form:

1.  Please provide the following contact information:

Name
Title
Organization
Street Address
Address (cont.)
City
State/Province
Zip/Postal Code
Country
Work Phone
Home Phone
FAX
E-mail
	When this form is received, the Internet does not automatically provide us with your email address, as is done with ordinary email.  So you must provide an email address in the space above so that we can reply to you.

Event date:

-- mm/dd/yy

Event time:

-- hh:mm:ss am/pm

Entertainment budget range in dollars:

[Be sure to consider travel expenses as well as a show fee when you determine your budget. Dr. Amazing tries to work within your budget.]

Event location:

Number of people expected to attend:

Type of  program(s) desired::

Hilarious Hypnosis Stage Show
Memory Improvement Seminar/Workshop

To schedule only a Memory Improvement Seminar/Workshop, go to Action Seminars, where a separate booking form is provided.

Dr. Amazing can customize programs for you. One of his specialties is to present a hypnosis show in the evening for a large corporate party, and on the following morning he will present a memory improvement seminar for an executive group or for a sales group.

Any additional information or questions you would like to submit: