Sheely Chiropractic Clinic

Sheely Group Communications

P.O. Box 169, 608 West State Street, Trenton, Ohio, 45067 Phone 513-988-9735

Website http://www.sheelychiro.com/ E-Mail drrob@sheelychiro.com

PROGRAM REQUEST FORM

DAY________________________ DATE _____________________ TIME____________________

ORGANIZATION _________________________________________________________________

CONTACT PERSON _______________________ PHONE _______________________________

MEETING PLACE____________________________ ROOM/BLDG._______________________

ADDRESS_________________________CITY________________________________

MEAL_____________YES__________ NO___________

SPEAKER TO TALK ________MINUTES. APPROXIMATE NUMBER ________

IF SPEAKER WISHES TO ILLUSTRATE THE TALK WILL A

a. SLIDE SCREEN BE AVAILABLE AT THE LOCATION OF THE TALK [ ] YES [ ] NO.

b OVER HEAD PROJECTOR BE AVAILABLE AT THE LOCATION OF THE TALK [ ] YES [ ] NO.

YOU WILL BE CONTACTED AS SOON AS YOUR REQUEST IS RECEIVED AND A PROGRAM ARRANGED.

PLEASE CHECK THE SUBJECT YOU WISH TO BE PRESENTED:

[] 1. "STRESS AND MUSCLE TENSION CONTROL - IT'S NOT JUST YOUR NERVES."

[] 2. "BETTER NUTRITION - IT'S NOT JUST WHAT YOU EAT."

[] 3. "SAFETY AND REDUCED BACK INJURIES AT WORK."

[] 4. "THE TENSION HEADACHE-HOW TO HANDLE IT."

[] 5. "LOWER BACK PAIN-WHY LIVE WITH IT?"

[] 6. "STRESS, SYMPTOMS, AND PAIN-THREE'S A CROWD."

[] 7. "RELIEF FOR LOWER BACK PAIN DURING AND AFTER PREGNANCY."

[] 8. "CHIROPRACTIC-THE NATURAL ROAD TO HEALTH."

[] 9. "POSITIVE MENTAL ATTITUDE-FOR IMPROVED RELATIONSHIPS WITH SELF, HOME AND

WORK."

[] 10. "GOAL SETTING-AND THE GOD GIVEN GIFT OF CHOICE"

[] 11. "SLOWING DOWN THE AGING PROCESS."

[] 12. "GROWING PAINS ARE NOT NORMAL IN YOUR CHILDREN."

[] 13. "SCOLIOSIS (CURVATURE OF THE SPINE) AND YOUR CHILD."

[] 14. "SPINAL HEALTH CARE" (ADULT OR CHILDREN'S PRESENTATION).

[] 15. "HEALTH CARE, POSITIVE ATTITUDES AND GOAL SETTING THREES COMPANY."

(ADULT OR CHILDRENS' PRESENTATION).

[] 16. "PRAYER, HEALING, AND CHIROPRACTIC-HOW DO THEY GO TOGETHER? - PERFECTLY!"

[] 17. "STRESS MANAGEMENT WORKSHOP."

[] 18. "HEALTH & WELLNESS IN THE WORK PLACE."

[] 19. "HEALTHY WORK RELATIONSHIPS"

[] 20. "HEALTHY CUSTOMER SERVICE"

PLEASE COMPLETE THE ABOVE FORM IN ONE OF THE FOLLOWING WAYS. . .

  1. COPY , PASTE IN YOUR E-MAIL, COMPLETE & E-MAIL
  2. PRINT OUT COMPLETE AND USE SNAIL MAIL TO SEND THE PROGRAM REQUEST FORM TO ABOVE ADDRESS.
  3. PRINT OUT, COMPLETE AND FAX THE PROGRAM REQUEST FORM TO 513-988-9220
  4. CALL 513-988-9735 ASK FOR ONE OF MY STAFF TO HELP YOU ARRANGE A PROGRAM FOR YOUR GROUP
(Talks can be customized for your particular group or presented on a special topic after discussion with Dr. Sheely)

TALKS are presented at no charge to schools, community clubs, and churches.

Business talks can be at no charge based on how much shameless promotion you allow me to provide about my services.

Many companies have used my enthusiastic presentation skills for employee motivation, understanding vision, living life with purpose, personal mission statements, and team building activities. Talks of this nature require a charge for businesses for my services even though I ecstatically enjoy providing them to excitedly screaming business groups.