Speaking & Media Requests
Thank you for your interest in booking with Atlanta Redemption Ink. Please fill out the section below to the best of your ability. If you do not have all the details yet, that is ok. We can not grant each request but each will be reviewed and we will respond in a timely manner.
Thank you
* Required
Name (include org, business, agency name if it applies)
*
Your answer
Phone Number
*
Your answer
email
*
Your answer
website
*
Your answer
name of organization/company
*
Your answer
type of request
*
Choose
community or awareness event
Church Service
Conference
Radio/Podcast
Online/Printed Article
Television/Media Interview
Magazine/Newspaper
None of these
Event Location
*
Your answer
Name of Event/Program/Show
*
Your answer
Date Requested for Event
*
MM
/
DD
/
YYYY
Requested Speaking time
*
Your answer
Event Start and End Time
*
Time
:
AM
PM
Event Description
*
Your answer
Estimated Audience Size
*
Your answer
Will we be speaking during multiple sessions/events
*
yes
No
TBD
Other:
Please share a little about the event/show audience demographics
*
Your answer
Length of speaking time
*
Time
:
AM
PM
Requested Topic (Jessica's Story, Atlanta Redemption Ink, Awarness and Tattoo Identification, etc)
*
Your answer
How Did you hear about Atlanta Redemption Ink/Jessica?
*
Your answer
Can You Provide the Following (if not local)
*
Hotel
Airfare
Other:
Required
Do you have a set honorarium
*
Yes
No
Will your organization or company be willing to?
*
Take Up a Donation for Atlanta Redemption Ink
Allow us to have an informational area
Other:
Required
Additional Information You'd like to share.
*
Your answer
Submit
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google.
Report Abuse
-
Terms of Service
-
Privacy Policy
Forms