Empowerment Month Host Registration
Thank you for your interest in becoming an Empowerment Month Host!
Email address *
Name of Host
Email
Phone number
Location of Empowerment gathering *
Please use full address
Date and time of Empowerment Gathering *
Please note that we can only do two locations per day due to limited staff. If your date has already been chosen more than twice we will contact you to choose a new date. Please only choose a date in the month of September.
MM
/
DD
/
YYYY
Time
:
Will you need Vista Maria to provide food for your guests? *
What program are you most interested in learning about during your presentation? *
Please list your guest and potential guest names. You can go back into your registration and update this list at any time. *
How many guests do you predict you will have? *
Are you also interested in becoming a sponsor of Empowerment Month? *
A copy of your responses will be emailed to the address you provided.
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