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
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
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?
*
Yes
No
Number of Speaking Sessions Requested
*
Please List The Day(s) and Time(s) You Would Like Shakeisha to Speak
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
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