Event Request Form

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Event Request Form

Full Name of Point of Contact (POC) *

Email Address *

Phone Number *

Address for Event or Training *

We are interested in *

Panelist

Speaker for an Event

Training for Adults

Awareness Table

Pop-Up store to help trafficking survivor

Training for school age students

Hosting the Girl Talk program at our church

Other:

Required

Level of Training Requested

Elementary (K-5th grades)

Intermediate (6-8th grade)

High School (9-12th grade)

Advanced (Professionals: Teachers, School staff, Community leaders, Parents..)

Not applicable to training I am requesting

Other:

Topics

Sex Trafficking

Labor Trafficking

Community-Specific Resources

Trafficking and Social Media (6th grade +) ( One 50 minute session)

iEmpathize: Empower Youth Program (6th+) (four 45 minute sessions)

Protect: K-12th ( Two 30 minutes session)

Healthy Vs. Unhealthy Relationships (7-12th)

Building Self-Esteem in Children

Social Skills through Art (K-5th grade)

Personal Value and Identity

Faith Based Exploitation Prevention

Girl Talk (self-esteem, self-respect, self- worth)

Other:

Please specify any any special questions or requests you have for training.

Dates Requested (top 3 choices, in order of preference) *

Arrival time for Set Up of presentation

Time

Presentation Start Time *

Time

Presentation Length *

Number of Attendees *

Focus/Objective of Event *

Will there be other speakers?

Yes

Clear selection

Venue Audio Visual Capabilities

Projector - HDMI

Projector - VGA

Screen

Sound System - microphone, speakers

Computer

DVD

None of the above

Other:

Will there be an informational table for ARK2Freedom? *

Yes

Maybe

We ask that your group or business would cover the cost of our team's time by making a donation to ARK2Freedom. Please review the following suggested donations. *

Keynote Speaker Fee Ranges from $150-500 depending on location, time, allotted to speak, and subject matter. More travel fees may apply.

Training, Workshop or classes - Donation of 25-$50 an hour to cover time, gas, and materials.

Panel Guest - Fees Range from $25 an hour depending on subject matter, speaker, and time commitment.

We can commit to asking our Small Group, Church Group, or Business Group would a love offering for ARK2Freedom..

I can not commit to donation at this time.

Required

Anything else we should know? *

Submit

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