Referral form

Thanks for your interest in Kevin's presentations and shows! This link was sent to you from someone who recommends you find out more about him! If you schedule him the next 6 months, you'll receive $25 worth of Kevin's books and CDs. And, the school/library/person who referred you to Kevin will also get $25 worth of his books and CDs.

Please fill out the following information and then click the submit button. We'll then be in touch as soon as we can. Also, feel free to also contact by phone or e-mail with any questions. After filling out the form, you'll have access to click on a link to see more details on how we calculate the rate.

Note: This page is not "published" on our website. It's only viewed when clicking on the direct link. So, keep that e-mail handy (where you clicked on this link). Especially if you want to look around the website and have trouble finding this page back!.

* Indicates required field

Name of person who referred you (so we can send them books and CDs)? *

The school, library, etc. that person is from? *

Your Name *

First

Last

Email *

Would you like your e-mail address added to our contact list to let you know about new books, CDs, shows, and special offers? *

Yes No

Title/Affiliation with School or Organization *

Best Phone Number to Reach You Directly *

Additional Phone Number for you? *

Name of School or Organization *

School District (if applicable) *

School or Organization Street Address (the actual location, not a PO Box please) *

City *

State *

Zip code *

School or Organization Phone *

School or Organization Fax *

School or Organization Website *

Rough estimate of the number of teachers in the school (if applicable) *

Rough estimate of the number of students in the school (if applicable) *

Grade levels of students in the school (if applicable) *

School Principal (if applicable) *

Librarian/Media Specialist (if applicable) *

Is there an additional person we can contact if needed? *

That Additional Person's Phone *

That additional person's e-mail *

When are you interested in Kevin visiting your school or organization? *

What presentations and/or shows are you interested in? *

Do you know how many presentations or shows you'd like? *

Additional information you'd like us to know? *

Questions for us? *

Submit