Speaker Request Form
Speaker Request Form: Please check the box indicating that you have read and understood the following statements.
Email address *
Samaria is a dynamic speaker, author, entrepreneur and trainer. She welcomes the opportunity to pour into the lives of others. Please complete the following information regarding your request to have Samaria speak. For any other business inquiries still, complete the form as well. Let's make a Kingdom Connection.
I understand that upon completing the form, we will get back to you within 24 to 48 hours in regards to your event. Samaria is not confirmed as a speaker (or participant of any kind) at your event until the contract is signed. Contracts will be emailed to you if your request is approved *
Required
Due to Samaria's schedule we ask that you give us at least 90 days notice prior to your event. Last minute request will be declined. Thank you. Please note for ALL requests Samaria does not do pre-consultation calls or meetings. Meaning Samaria does not assist in preplanning or helping you plan your event. *
Required
Your request will not be considered if you don't have the specific date (s), time and venue (location) of your event. *
Required
An honorarium is requested *
Required
NAME OF THE COMPANY/ORGANIZATION/MINISTRY
*
Your answer
Name of Organizer *
Your answer
THEME OF EVENT
Please be specific
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Your answer
DATE OF THE EVENT *
MM
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YYYY
The address of the event *
Your answer
TIME OF EVENT *
Time
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Phone number of the organizer *
Your answer
WHAT IS YOUR SPEAKER BUDGET? WILL SAMARIA BE ALLOWED TO PROMOTE HER PRODUCTS, BOOKS, FUTURE EVENTS AND SERVICES? PLEASE BE AWARE THAT SAMARIA DOES NOT PAY FOR VENDOR TABLES TO EVENTS SHE IS A REQUESTED PARTICIPANT AT. *
Your answer
IS THERE A CHARGE FOR YOUR EVENT? IF SO HOW MUCH? *
Your answer
WILL TRAVEL/HOTEL ACCOMMODATIONS BE OFFERED? PLEASE BE AWARE THAT SAMARIA IS IN GREENSBORO NC FOR ALL LONG DISTANCE, OUT OF TOWN AND OVERNIGHT EVENTS ACCOMMODATIONS (INCLUDING TRAVEL REIMBURSEMENT) ARE REQUIRED *
Your answer
HOW WOULD YOU LIKE SAMARIA TO CONTRIBUTE TO YOUR EVENT? *
Required
ANY ADDITIONAL INFORMATION YOU WOULD LIKE FOR SAMARIA TO KNOW OR CONSIDER? *
Your answer
Please be aware we do not communicate any business related matters over text message, DM, FB messenger or social media. We will communicate directly via the business phone number and email you provided us. *
Required
For more information about Samaria's mission and to view other products, events and services visit the website at www.samariacolbert.com. Please do not use this form for counseling inquiries go to Kingdom Creative Counseling PLLC by visiting the website www.kingdomcreativecounseling.com Any changes that you need to make, we will not communicate via text message, dm or social media. If changes are made contact us via the phone or email, we will amend you request as needed or you may resubmit your request *
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