Dr. Chiquita Miller Request Form
Thank you for your interest in having Dr. Chiquita, minister at your event. We need a little information from you before we can get an answer to you. Please try to put in as much information as possible so that she will have enough details as she prayerfully seek God regarding your request. If this is the 1st time you've held your event you may have to estimate some of your answers. We ask that you allow 1 to 2 weeks to receive an answer. Also please make sure all contact info has been entered correctly, in case there are any questions and we need to contact you. May God abundantly bless your event!
Email address *
Service Request *
Please select the type of service you would like Dr. Miller to provide
What is the name of your event? *
Your answer
What is date(s) and time of your Event? *
Your answer
Organization Name *
Your answer
Organization Address *
Your answer
Organization Phone Number *
Your answer
Website
Your answer
Your name and position *
Your answer
Your Phone number *
Please enter your BEST Contact number
Your answer
Request Details *
Please use this opportunity to describe your event in detail and Dr. Miller's role in it.
Your answer
How often do you hold this event? *
Your answer
Will Dr. Miller be able to set up a product table? If yes what is the estimated attendance? *
Not applicable for weddings
Your answer
What travel arrangements can Dr. Miller expect to be covered by your organization? *
Flight
Hotel
Car
Other
Select All that Apply
If you selected OTHER please provide details.
Your answer
Do you have a budget set for an honorarium? If so what is the amount she can expect to receive? *
Your answer
ADDITIONAL INFORMATION: Please use this space to add any information you feel Dr. Miller needs to know as she commits this request to prayer.
Your answer
A copy of your responses will be emailed to the address you provided.
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