LS Online Speaker Registration Form

Guest Speaker Registration

Workshop/E-course
We want to accommodate you well when you come visit us! The following are some questions to help us know how to best serve you. Thank you for completing this form and sending it back to us.

Note: Not all categories may apply to your visit, but please complete all that do.

We look forward to seeing you!
Name*

PrefixFirst NameLast Name
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Phone Number*

Area CodePhone Number
E-mail*
Personal Bio
Please include a short bio of yourself that we can share with possible workshop attendees
Please upload a picture of yourself or image you would like us to use for your workshop / e-course

Browse Files
You may include several files for us to choose from Cancelof

Workshop Details
Suggested Name of Workshop or Course and Short Description*
This will appear as the main description of the workshop and e-course
Date of workshop*

MonthDayYear
Date
Number of Sessions*
Multi day workshop?

Yes
Workshop START and END Times

:HourMinutesAM/PM Option
Until
until :HourMinutesAM/PM Option
2nd Day Workshop START and END Times

:HourMinutesAM/PM Option
Until
until :HourMinutesAM/PM Option
Each workshop will be broken up into sessions. Each Session will be comprised of elements like teaching, session activation, Q&A, etc. and should not exceed 1hr per session.

It is expected that each workshop will be unique. Some workshops might have several teaching sessions and then a final activation followed by Q&A. While others may have an activation and Q&A with every session.

Please help us have a better idea of the stucture of your workshop with the questions below.
Please describe workshop components, sequence, etc. Include names for any of your sessions or activation if applicable.*
i.e. Prayer/ Sessions (Session 1/ Activation/ Q&A/ repeat for each session) / Final Activation
Do you have any special media requirements while speaking? Please give specific information as in the showing of videos/presentations/supplies needed for illustration or activation, Windows/Mac preference, etc.)
Suggested Cost to attendees. If any, what does the cost cover?
Final amount for workshop/e-course students may be set by Life School to cover production costs

Travel and Communication Preferences
What kind of travel expenses and lodging do you require?
What is your arrival date and time? Length of stay: (nights needed for housing)
If you would prefer us to communicate with an assistant, please provide your assistant's name and email.
Any personal food restrictions or preferences?
Will you be bringing books, materials and/or products to sell?*

YesNo
Please specify the type of products you wish to sell during your stay & any equipment or supplies needed for a product table.
We will do our best to accommodate.

Payment information if applicable
What is the name or organization you would like a check issued to?
- For payment/honorariums, please provide your mailing address if different from address above:
Mailing address:

Street Address or P.O. Box

Street Address Line 2

CityState / Province

Postal / Zip Code
***Payment/Tax Information***

Please print the W-9 form below, or you can fill it out online at: https://www.irs.gov/pub/irs-pdf/fw9.pdf. Please bring completed form with you or email signed form to lsfinances@lifeschoolsalem.com.

Thank you
W-9

Anything else? & Submit Form
Is there anything else you would like us to know?
By submitting this form, you acknowledge that you are the speaker(s) named above or have permission to consent on behalf of the speaker(s) named above to the following: You consent to the speaker(s) voice, and likeness being videotaped and used without compensation, unless otherwise specified, for use by Life Church / Life School and its affiliates, and you release Life Church / Life School and its affiliates from any liability on account of such usage. You agree to adhere to the guidelines described above for the sale of books & products.
Should be Empty:

Guest Speaker Registration