Speaker Request Form

If you would like to request a representative of Street Grace to participate in your event, please fill out and submit the form below.

Name*
FirstLast
Phone Number*
Email*
Site of Event*
Site Address*
Street AddressAddress Line 2CityState / Province / RegionZip / Postal Code
Date of Event*
MM
DD
YYYY
Event Time - start to end*
If the time that the speaker would need to be present at your event is different than the event time listed above, please clarify that here.*
Speaker fees are listed below. Checks should be made payable to Street Grace. Speaker fees are waived for Church Partners, elementary, middle and high schools. All other requirements apply. For information on church partnership, please contact Whitney.Bexley@streetgrace.org. *
- $150 Honorarium within 50 mile radius of Street Grace office (Norcross, GA)
- $150 Honorarium plus meals and mileage over 50 miles from the Street Grace office in Norcross. In addition, any extensive travel may also require lodging accommodations. Please note, under those circumstances Street Grace employees/volunteers travel in pairs. Please contact Amy@streetgrace.org with any questions.
Do you want to show The Candy Shop Film?
- Yes
- No
Length of time given to Street Grace Speaker (A minimum of 30 minutes is required. If you would like to hold a viewing of the film, "The Candy Shop," the length of a speaking engagement may be no shorter than 1 hour.)*
Other speakers you will be inviting to the event*
Expected Number of Attendees*
Please explain how you are marketing your event.
Detailed Description of Event*
How did you hear about Street Grace?
What are you hoping your event will gain with the addition of a Street Grace speaker?
What is the expected outcome of your event - your call to action?
What type of A/V equipment will you provide for the presentation? Will there be someone on site the day of the event to provide technical assistance?*
What education has your group already had on DMST?
Can you please describe your room set-up.
Request Fulfillment
- I understand that this form operates only as a request. The completion and submission of this form does NOT signify that Street Grace has agreed to participate in my event. Furthermore, I understand that any and all speaker requests are fulfilled on the basis on availability which cannot be guaranteed.