Engage

& Motivate People

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Full Name:

Organisation Name:

Email Id:

Contact Number:

Program Type:

Topic/Theme:

Date of Program:

Flexible with Date:

   YES     
  NO     

Program Venue:

City:

Address:

Keynote (approx One to one-and-a-half hours) or Half day (3 hours with one break)?:

Multiple Presentations/locations (Y/N)?:

   YES     
  NO     

Audience Size:

Audience Profile:

What one thing you would like your audience to walk away with, upon completion of Mr. Khan's program?:

To reinforce the message, would you like to give Mr. Khan’s autographed copy of book to the audience?:

   YES     
  NO     

Additional Information: