*Date of event


CONTACT DETAILS

*Name of church or organization


*Name of person filling out this form
First Name                  Last Name


Relationship (title) to above organization


*Contact person (if different from above)


*Email address of contact person


*Address

EVENT DETAILS

Where is this event being held?
*Name of Venue


Address

What type of event is this?
(Retreat, conference, brunch, dinner, etc.)

AUDIENCE DETAILS

If the event is youth or college, will it be co-ed or all girls?
Co-ed All girls

Will this be promoted as a communitywide event?
Yes No

Has the event (as well as Debi's role in the event) been approved and confirmed with the staff of your organization?
Yes No

How many guests are you expecting to attend?


What is the age range of your expected audience?


What is the spiritual makeup of the audience?
(Estimated percentage of believers, seekers, etc.)


If you have had this event in the past, how many attended?


Will there be a concert or other components in your event? If so, please list.


SPEAKER DETAILS

Will additional speakers be involved? If so, please list.


Will there be a prayer team for this event?
Yes No

What is your budgeted speaking fee?


May Debi bring her books to sell at this event?
Yes No

Start time of the event?
Date: / /

Time:

End time of the event?
Date: / /

Time:

How many times would you like Debi to speak?

Which presentations from Debi's list of available topics most interest you?


What is the overall goal you hope to accomplish at this event?


How did you hear about Debi Stack?