Resource - Speaker Request Form for Sara Robinson

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Requesting Sara Robinson, KBC Women's Ministry & Transition Consultant, as a Speaker / Attendee for your event is easy:

Complete the online speaker request form and press the submit button.
Either a Ministry Assistant or the Consultant will review your request and contact you.
Please note that our goal is to contact you within 24 hours of your request (if submitted on a weekday) however, your request could take up to 1-2 weeks to process so please plan your event accordingly.

Your Contact Information:

Name*

Email Address:*

Office Phone Number*

Yes, it's okay to send me text messages including confirmations, changes, and updates. Message frequency varies. Message and data rates may apply. Reply STOP to cancel. View our terms of service & privacy policy.

Cell Phone Number

Yes, it's okay to send me text messages including confirmations, changes, and updates. Message frequency varies. Message and data rates may apply. Reply STOP to cancel. View our terms of service & privacy policy.

Church Name

Event Overview:

Event Title

Name of Church/ Ministry/ Organization Presenting Event*

Please give a brief description of your organization*

What is the purpose of this event?*

Audience (select all that apply)*

Women
Students / Youth
Congregation
Business Leaders
Educators
Elected Officials
General Public
Other

If audience is "other", please specify

Anticipated Audience Size

Event Address/Location*

Will this event be in person?*

Yes
No
Unsure

Event Date (preferably at least 60 days out)*

Is this date flexible?

Yes
No

Event Starting Time*

Event Ending Time*

Time Zone*

Are these times flexible?

Yes
No

Expected Media Coverage?

Yes
No

If yes, which media outlets?

Will this presentation be recorded or made public?

Will this presentation be webcast/streamed?

Presentation Details:

Topic of Requested Presentation*

Background or purpose of event*

Proposed Agenda (upload file)

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Sara's Proposed Role (select all that apply)*

Attendee
Break-out Session
Brief Remarks
Emcee
Honoree
Keynote Address
Media Interview
Panel Discussion
Plenary
Podcast
Presentation
Workshop Leader / Teacher
Other

If other, please specify

Length of requested presentation*

If "Multiple Days" was selected, please specify

Confirmed or other invited speakers/ panelists (please include titles)

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