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, updates, and/or promotions. 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, updates, and/or promotions. 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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