Speaker Invitation Form - Shakeisha Johnson
Which of the following are you requesting?
*
Speaker
Panelist
Workshop Facilitator
Will you be requesting any of the folowing?
Digital material (Powerpoint, video, etc.)
Printed worksheets or other printed material
Custom Curriculum
Your Name
*
First Name
Last Name
Your Contact Email
*
example@example.com
Your Contact Phone Number
-
Area Code
Phone Number
Your title/position
Name of Organization or Ministry
*
Organization or Ministry Website
*
Name of Requested Event or Conference
*
Theme(s) and/or Focus of Gathering
Date of Event
*
/
Month
/
Day
Year
Date
Event start time
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12
:
Hour
00
10
20
30
40
50
Minutes
AM
PM
AM/PM Option
Speaking Time Allotted
1
2
3
4
5
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11
12
:
Hour
00
10
20
30
40
50
Minutes
AM
PM
AM/PM Option
Until
until
1
2
3
4
5
6
7
8
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10
11
12
:
Hour
00
10
20
30
40
50
Minutes
AM
PM
AM/PM Option
Expected Number of Attendees
*
Event Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Please indicate your proposed budget for this request.
*
Will Hotel and Travel Expenses be covered? (For events outside of Nassau Bahamas)
Yes
No
Number of Speaking Sessions Requested
Please List The Day(s) and Time(s) You Would Like Shakeisha to Speak if there is more than one request.
Will There be a Resource Table Available?
*
Yes
No
Will There be a Volunteer Available to Run the Resource Table?
Yes, we will have a volunteer available.
No, Shakeisha will need to provide someone to run their resource table.
Additional Relevant Information or Requests
Submit
Should be Empty: