Speaking Invitation Request Form

Harmony Dust Speaking Invitation Request Form
If you are interested in having Harmony speak at your church, event or organization, please take a moment to fill out the info below. Thank you so much!

Organizational Information
	Name of Organization*
	If this is a church, Name of Senior Pastor(s)
	Main Contact*
	Phone Number*
	Email Address
	Address*
	Address (2nd line)
	Website
Event & Speaking Details
	Name of Event*
	Date of Event*
	Location of Event*
	Time of Event*
	Event Theme / Description*
	Estimated Event Attendance
	Will Harmony be speaking at multiple sessions?*
	Speaking Time(s)*
	Length of Speaking Time*
	Is there any specific theme or message that you would like Harmony to speak on?
	Harmony typically receives $1,000 for a speaking session, and $500 for each additional session. If you need her to speak more than twice, we can discuss further payment. However, we are here to serve and want to work within your budget if possible. If this is something that would be a challenge for you, please do not hesitate to initiate further dialogue? *
	Will someone be available to manage the Treasures resource table?*
Airfare & Hotel
	Airfare
	Generally, we prefer to book 2 coach tickets for travel. One for Harmony and one for a companion. If this is a challenge, please let us know, and we will gladly work towards a solution. We are flexible and want to serve.
	Will you be able to provide 2 coach tickets?*
	Hotel
	Generally we prefer the host/coordinator to book the hotel accommodations. One room is needed.
	Will you be able to provide hotel accommodations?*
Miscellaneous
	How did you hear about Harmony or Treasures?
	Notes, questions, or additional info
	Input the Verification code you see above*

	Please let us know if you have any questions or concerns. Thank you!
	www.iamatreasure.com Nissa@iamatreasure.com 323-937-9525 PO Box 2013 North Hills, CA 91343-2013