Speaker Engagement Form
Pastor Anika Wilson-Brown, MSW, LGSW thanks you for your invitation to share at your church or organization event. Please complete this form to request her presence at your event. This form is a request for to gather information and should not be considered a confirmation. Anika believes in the power of presence and looks forward to serving your vision. She is honored by your invitation and expects bring great impact to your ministry/organization. Upon receipt of all pertinent details, the AWB Experience team will be in contact with as soon as possible. Thank you and may God bless you ABUNDANTLY!
Ministry/Organization Information
Ministry/Organization Name
*
Pastor/Host Name
*
First Name
Last Name
Ministry/Organization Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Phone Number
*
-
Area Code
Phone Number
Fax Number
-
Area Code
Phone Number
Event Information
Please share the details of your event so that we can best serve your needs.
Event Name
*
Type of Event
*
Banquet/Luncheon
Church Anniversary
Church Dedication
Conference/Convention
Media Request (i.e., interview, radio, podcast, etc)
Revival
Special Program
Worship Service
Other
If you indicated "Other" above, please describe the event
What service do you want AWB to provide?
*
Preached Word
Workshop
Training
Consultation
Group Therapeutic Coaching
Please indicate the Theme or Scriptural reference being used for the event below.
Date Requested (or first day if multiple dates)
*
-
Month
-
Day
Year
Date
Event Start Time
*
1
2
3
4
5
6
7
8
9
10
11
12
:
Hour
00
10
20
30
40
50
Minutes
AM
PM
AM/PM Option
Event Ending Time
*
1
2
3
4
5
6
7
8
9
10
11
12
:
Hour
00
10
20
30
40
50
Minutes
AM
PM
AM/PM Option
Event Address if different from Ministry/Organization Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Closest major airport to the event (if travel from Washington, DC is required)
What is the approximate distance, in miles, from the closet major airport to the event location (required if travel outside of Washington, DC area is required)
What is the approximate distance, in miles, from Washington, DC (if driving)
Has AWB previously been a Guest Speaker/Facilitator at one of your events?
*
Yes
No
Anticipated attendance fo event
*
1-15
16-49
50-99
100-250
251-499
500-1499
1500+
Is there registration cost to attend the event?
*
Yes
No
If YES, what is the cost for registration?
Is this event being broadcast lie via the Internet or television?
*
Yes
No
Would you like the UTBC Praise Team to accompany AWB?
*
Yes
No
Do you allow the sale of AWB ministry products?
*
Yes
No
Honorarium offer from your ministry/organization for AWB experience
*
Please enter a dollar amount or range of honorarium offer.
What is your prayer/vision for this event? What do you want the participants to leave with?
*
Additional event details (e.e., multiple dates, event type, etc.)
Names of other participating speakers and their ministry dates and times:
Contact Information
Please provide the name and information for the person who will be the primary contact for AWB Experience team.
Contact Person
*
First Name
Last Name
Contact Person Email
*
example@example.com
Contact Phone Number
*
-
Area Code
Phone Number
Phone Alternate Number
-
Area Code
Phone Number
Submit
Should be Empty: