Booking Form for Dr. Darlene Allen Nichols
Thank you for considering Dr. Darlene for your upcoming event, Our team will review and respond within 48 hours of receipt.
Who are you inviting to speak?
*
Pastor Dr. Darlene Allen Nichols, PhD
Pastor Eugene Nichols, Jr
Your Name
*
First Name
Last Name
Your Contact Email
*
example@example.com
Your Contact Phone Number
-
Area Code
Phone Number
Name of Organization
*
Name of CEO/Pastor
Organization Website
*
Name of Event, Conference, Service, etc.
*
Specific Request
Keynote Speaker
Session Facilitator
Guest Lecturer
Guest Panelist
Panel Session Facilitator
Mistress of Ceremony
Leadership Seminar
Group Counseling Session (Illinois only)
Date of Event
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/
Month
/
Day
Year
Date
Time
AM
PM
Time of event
Expected Number of Attendees
*
Event Address
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Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Is travel Required?
YES
NO
Will There be a vender table available?
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Yes
No
Will There be a Volunteer Available to Run the Resource Table?
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Yes, we will have a volunteer available.
No, Dr. Darlene 's team will need to provide someone to run their resource table.
Theme(s) and/or Focus of event
Additional Relevant Information or Requests
Submit
Should be Empty: