Skip to content
Search for:
WATCH
Watch Live
Watch on YouTube
ABOUT US
Pastor’s Page
Guiding Principles
History
EVENTS
GIVING
YES
Resources
Employment
Request Services
Ministries
Freedom School
Small Groups
Community Portal
2024 Voting Info
News
News
Newsletter
BOOKSTORE
Speaker Request Form
Home
Speaker Request Form
Speaker Request Form
@@dmNnI088754
2022-06-06T20:57:43-04:00
Rev. Danté R. Quick, Ph.D.
Senior Pastor
Speaking Requests
"
*
" indicates required fields
Step
1
of
5
20%
Event Primary Contact
Name
*
First
Last
Organization Name
*
Email
*
Office Phone
*
Moblie Phone
*
Is the Primary Contact the same as the "Day of the Event" Contact?
Yes
No
Event Details
Host Organization
*
Type of Organization
*
State Association
Regional Association
HS Program
Other
If other, please provide details below
Name of Event (please include a brief description)
*
Event Start Date
*
MM slash DD slash YYYY
Event End Date
*
MM slash DD slash YYYY
Expected no. of attendees
*
Venue Name
*
Venue Address
*
Venue City
*
Venue State
*
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Puerto Rico
Virgin Islands
Northern Mariana Islands
Guam
America Samoa
Palau
Venue Zip Code
*
Overall Topic(s) for discussion/presentation
*
Speaking and Meeting Requests
Date of Speaking Engagement
*
MM slash DD slash YYYY
Time Slot of Speaking Engagement
*
Hours
:
Minutes
AM
PM
AM/PM
Speaker's Role for Speaking Engagement
*
Keynote
Moderator
Panelist
Presenter
Meeting Participant
Strategic Planning
Advocacy Events
Other
Type of Event
*
Room No.
Description
*
If a PowerPoint will be used during a presentation, is it acceptable for the presentation to be provided via flash drive?
Yes
No
If a PowerPoint will be used during a presentation, will a projector and a computer be provided for the speaker?
*
Yes
No
Due to the Covid - 19 pandemic, we are only able to accept invitations to virtual events. Please use this form, but skip any travel details. ~ Thank you
Additional Information
Please upload the Program Booklet for the Event
Max. file size: 256 MB.
Please upload the "Schedule at a Glance"
Max. file size: 256 MB.
Information needed from FBC (please check all that apply)
Speaker Bio
Flight Itinerary
Photo of the Speaker
Additional Information and Requests
Logistical Information for Speaker
Please list 1-3 major airports near the hotel where the speaker will be staying
Is there an existing hotel reservation for the requested speaker ?
Yes
No
Hotel where the speaker will be staying
Hotel Address
Hotel City
Hotel State
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Puerto Rico
Virgin Islands
Northern Mariana Islands
Guam
America Samoa
Palau
Hotel Zip Code
Does the hotel have shuttle service to and from the airport?
*
Yes
No
Hotel is the same as the venue location listed above
Yes
No
Costs Incurred by Speaker
Will all travel and lodging costs for NHSA staff be covered by the requester?
*
Yes
No
ACKNOWLEDGEMENT: By clicking yes, the requester is in agreement to pay for all of the speaker's costs including travel, meals, and any other possible expenses. Please sign your name below.
Name
*
First
Middle
Last
Job Title
*
Please include who should receive invoicing (usually 30-60 days, post event)
Name of Organization
*
Name
*
First
Last
Job Title
*
Email
*
Phone
*
Thank you for requesting a member of the FBC staff to participate in your event. Your request will be reviewed by FBC staff and you will receive a response within 5 business days.
Page load link
Go to Top