Preliminary Booking Form
General Ministry Information
Ministry Name
*
Host Name
*
First Name
Last Name
Contact Number
*
Format: (000) 000-0000.
Contact Email Address
*
example@example.com
Ministry Mailing Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Event Information
Name of Event
*
Type of Event
*
Conference, Panel, Ministry Event, etc.)
Event Theme
*
Venue
*
Number of Attendees
*
Venue Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
What Language(s) Will be Used during the Event?
*
English
Spanish
Both
Requests Information
Date(s) and Time(s) Requested
*
Request
*
Keynote Speaker
Workshop Facilitator
Breakout Session
Other
Length of Session
*
Time
Day(s) of Session
*
Time(s) of Session
*
Time Event Begins
*
Hour Minutes
AM
PM
AM/PM Option
Your Time Zone
*
EST
MST
CST
PST
Your Event Budget
*
Honorarium
*
Will You Publicize the Event?
*
Yes
No
If So, How Will You Publicize the Event?
Is this a Ticketed Event?
*
Cost of Ticket(s)?
*
Will this Event Be Audio Taped?
*
Yes
No
Will this Event Be Video Taped?
*
Yes
No
Lodging Accommodations
Hotel Name
*
Hotel Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Front Desk Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Confirmation Number
*
Confirmation # for Dr. Terika's Lodging
Room Type
*
Check-In
*
-
Month
-
Day
Year
Date
Check-Out
*
-
Month
-
Day
Year
Date
Transportation
Driver's Name
*
First Name
Last Name
Driver's Mobile Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Expected Pick-Up Times for Service
*
Submit
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