First Name
Last Name
Title
Organization
Work Phone
Fax
E-mail

Enter the Month of the event :

January  February  March  April  May  June  July  August  September  October  November  December 

Enter the day of the event :

1st  2nd  3rd  4th  5th  6th  7th  8thr  9th  10th  11th  12th  13th  14th  15th  16th  17th  18th  19th  20th  21st  22nd  23rd  24th  25th  26th  27th  28th  29th  30th  31st 

Enter the year of the event :

2010  2011  2012  2013  2014  2015  2016 

Type of event planned:

Corporate Event  Theme Park Event  Fair  College or University  High School  Comedy or Night Club  Casino  Special Event  Private  Seminar  Speaking Engagement  Other Type Not Listed 

How did you hear about SZELES?:

Web  Magazine Ad  Surfing the Internet  YouTube  FaceBook  Word of Mouth  Hired Szeles in the Past  Seen Szeles perform  From a Past Client  Search Engine 

Estimated audience attendance:

50 to 100  100 to 250d  250 to 500  500 to 1000  1000 to 3000k  3000 to 5000h 

Location of event (very important- city and state):

What kind of show would you like:

G-Rated politically correct  PG-Rated a little spicy  R-Rated some sexual routines 

G – Very clean. Suitable for family or conservative groups. No strong language and little or no sexual dialogue or situations.

PG – Mild, adult-oriented subject matter and/or language used in moderation or infrequently.

R – Mature adult subject matter and/or language used liberally. Night-club appropriate.

General Information:

Have you hired a stage hypnotist previously?

Yes  No

Are you a entertainment agency?

Yes  No

Additional information or questions:

 

*(Optional) Did the flying monkeys in the Wizard of Oz scare you?

Yes  No

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