Speaker Presentation Request Form

Thank you for your interest in booking Adrienne McCollum-Smith for a speaking engagement or workshop. Adrienne accepts a limited number of engagements each year and prioritizes opportunities that align with her mission of healing, education, and empowerment.

Honorarium rates typically range from $300–$750 for churches, nonprofits, and community-based events, and start at $1,000 for corporate or professional audiences. Please complete this form to help us determine fit and availability.

Name of Contact Person

Email Address

example@example.com

Phone Number

Organization/Institution Name

Website or Social Media if applicable

Event Theme or Topic

Type of Event: (e.g., Conference, Church Service, Workshop, Panel, Retreat, Training, Podcast, etc)

Date of Event

Date

Event Time

Event Location (City/State or Virtual)

Is this event in-person, virtual, or hybrid? (Select one)

Target Audience: (e.g., youth, women, professionals, therapists, general public, etc)

Estimated Number of Attendees

Admission Cost to Participants?

Has this event been held before?

If yes who were past speakers if any

Requested Speaking Topic or Area(s) of Expertise:

Length of Presentation: (e.g., 15 min keynote, 45 min workshop, 1-hour panel)

Explain "Other"

Will a Q & A be included?

Is a PowerPoint or multimedia presentation expected?

Will an honorarium or speaking fee be provided?

Will travel/lodging be provided for in-person events?

What is your available budget for this event?

$300–$500 (Community/Nonprofit Rate)$500–$750 (Standard Rate)$1,000+ (Corporate/Professional Rate)I am requesting a pro bono or reduced-fee presentation (limited availability)

Additional Notes or Requests (Use this space to include any other important details or special requests for the speaker)