Speaker Invitation Form
Who are You Inviting To Speak?
*
Whitney Jones (Founder/CEO)
Debra Trice (Director of the Redemption/Prison Outreach Program)
Whitney Jones & Debra Trice
Your Name
*
First Name
Last Name
Your Contact Email
*
example@example.com
Your Contact Phone Number
Name of Business
*
Business Website
*
Name of Requested Event or Conference
*
Theme(s) and/or Focus of Gathering
Date of Event
*
/
Month
/
Day
Year
Date
Expected Number of Attendees
*
Event Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Will an Honorarium be Provided?
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Yes
No
Will Hotel and Travel Expenses be Reimbursed?
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Yes
No
Number of Speaking Sessions Requested
*
Please List The Day(s) and Time(s) You Would Like Whitney and/or Debra to Speak
Will there be a Resource Table Available?
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Yes
No
Will there be a Volunteer Available to Run the Resource Table?
*
Yes, we will have a volunteer available.
No, Whitney and/or Debra will need to provide someone to run their resource table.
Additional Relevant Information or Requests
Submit
Should be Empty: