Scheduling Request

1

Is this your group's first time to request a WallBuilders Speaker?* This field is required.

YesNo

2

Type of Event* This field is required.

3

Your Speaker Preference* This field is required.Who would be your first choice for a speaker?

Tim Barton

David Barton

Rene Diaz

Matt Krause

4

David Barton's honorarium is $6,000

YesNo

5

Tim Barton's honorarium is $4,000

YesNo

6

Rene Diaz's honorarium is $2,000

YesNo

7

Matt Krause's honorarium is $2,000

YesNo

8

If your preferred speaker is not available, would you like us to transfer your request to another of WallBuilders' speakers?

YesNo

9

Event sponsor agrees to pay the travel expense by the due date given in the contract. These expenses are billed at a flat rate, and include all applicable airfare, lodging, transportation, food, tolls/tips/misc. WallBuilder Presentations reserves the right to cancel participation if payment is not received by the requested date.* This field is required.

I acceptI don’t accept

10

The Event Sponsor is aware that an honorarium is required in addition to the travel expense.* This field is required.

I acceptI don’t accept

11

Is this event a multi-day event where the WallBuilders Speaker will speak more than one day?* This field is required.Please note: The honorarium increases by 50% for every additional day our speakers are presenting Travel fees may also be increased to cover additional days

YesNo

12

Event Date* This field is required.

mm-dd-yyyy

13

Event Time* This field is required.

14

Event Start Date* This field is required.

mm-dd-yyyy

15

Event Start Time* This field is required.

16

Event End Date* This field is required.

mm-dd-yyyy

17

Event End Time* This field is required.

18

Speaker Involvement* This field is required.What do you envision the speaker doing for your event?

19

Other ParticipantsPlease list any VIP's or Individuals the speaker might want to know will be present at your event

20

Name of Venue* This field is required.Please tell us the name of the place where the event will be held.

21

Event Address

Address

City/Town

State/Region/Province

Zip/Post Code

Country

22

Expected Attendance* This field is required.

23

Description of Audience* This field is required.

24

CommentsAnything else we should know?

25

Your Name* This field is required.

First Name

Last Name

26

Are you a Pastor?* This field is required.

PastorNot a Pastor

27

Your Phone Number* This field is required.

Please enter a valid phone number

28

Your Email* This field is required.

example@example.com

29

Would you like to receive email updates and newsletters from WallBuilders?

YesNo

30

How did you hear about us?* This field is required.

31

Organization Name* This field is required.

32

Organization Website* This field is required.

33

Is this a Church or Ministry?* This field is required.

YesNo

34

Are you in the Leadership role in your Organization for this event?* This field is required.

YesNo

35

Leader's Full Name* This field is required.

First Name

Last Name

36

Leader's Phone Number* This field is required.

Please enter a valid phone number

37

Leader's Email* This field is required.

example@example.com

38

Data Source

Events

39

Is this leader a pastor?* This field is required.

PastorNot a Pastor

40

Event Dates (Multiple)

41

Event Times (Multiple)