Candie A. Mitchell-Price Speaker Request Form

Candie A. Mitchell-Price Speaker Request Form
Your Name*

First NameLast Name
Your Contact Email*
example@example.com
Your Contact Phone Number
Name of Church or Ministry *
Church or Ministry Website*
Name of Requested Event or Conference*
Theme(s) and/or Focus of Gathering
Date of Event *

MonthDayYear
Date
Expected Number of Attendees*
Event Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Number of Speaking Sessions Requested*
Please List The Day(s) and Time(s) of Speaker Sessions
Honorarium*
*Honorarium is separate from travel, ground transportation, and hotel accommodations. Requested party/organization should expect to cover all aforementioned expenses.
Will There be a Resource Table Available?*

YesNo
Additional Relevant Information or Requests
Straight Outta Brokenness Book Tour
Should be Empty: