Fortify Presenter Request Form

PRESENTER REQUEST FORM

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Requester Information

Requesting Organization Name(Required)

Requesting Org Point of Contact Name (first and last)(Required)

Point of Contact Position/Title(Required)

Point of Contact Email Address(Required)

Point of Contact Phone(Required)

Please share your organization's URL if you have a website

Event Details

Time of Event(Required)

Date of Event(Required)

Where will the event take place?(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Event Venue/Location Name(Required)

What is the nearest airport to the event location?(Required)

Is there any flexibility in this date based on presenter availability?

Yes

Describe your audience(Required)

Pastors, ministry leaders, associational leaders, etc.

What is your projected attendance number?(Required)

What is your requested dress code for presenters?(Required)

What are your pre-event expectations?(Required)

Do you want to review material in advance? How many meetings do you anticipate with speakers before the event? Any other requirements of speakers in advance of the event?

What is your deadline for submitting slides or other media (if applicable)?

Will the event be recorded?(Required)

Audio

Video

Not Recorded

Other

What is your honorarium budget?(Required)

What is your budget/policy for covering speaker travel expenses?(Required)

What other speakers (aside from the ones you're requesting here) are you anticipating for the event?

Is there any other information you would like presenters to know about your event?

Can you share schedule of your event?

*See sample schedules on the Event Plans page.

Speaker 1 Information

Speaker Selection 1(Required)

Select Topic(s) – Thomas Jordan

Crisis Response

Select Topic(s) – Chris Atkins

Crisis response

Operations / Supervision

Training

Select Topic(s) – Emily Smith

Abuse Prevention & Response Foundations

Safeguarding the next generation (ministry leaders and parents)

Screening

Training

Child Safety Coordinator

Grooming

Developing Policies and Procedures to Protect the Vulnerable

Select Topic(s) – Amber Privett

Abuse Prevention & Response Foundations

Caring well / Church cares

Crisis response

Grooming

Response plans

Survivor care

Training

Select Topic(s) – Lynne Little

Abuse Prevention & Response Foundations

Safeguarding the next generation (ministry leaders and parents)

Select Topic(s) – Davis Younts

Select Topic(s) – Kris Buckman

Select Topic(s) – Brad Eubank

Select Topic(s) – Keith Myer

Abuse Prevention & Response Foundations

Governance

Training

Caring well / Church cares

Survivor care

Leading Change as a Pastor

The Role of the Associational Leader Leading Without Controversy

State Convention Level Change

Select Topic(s) – John Murphy

Abuse Prevention & Response Foundations

Crisis response

Governance

Risk management / insurance

Screening

Training

Select Topic(s) – Sara Robinson

Abuse Prevention & Response Foundations

Caring well / Church cares

Grooming

Safeguarding the next generation (ministry leaders and parents)

Training

Select Topic(s) – Jenny Estrada

Abuse Prevention & Response Foundations

Child Safety Coordinator

Safeguarding the next generation (ministry leaders and parents)

Screening

Select Topic(s) – Manny Keyser

Abuse Prevention & Response Foundations

Caring well / Church cares

Crisis response

Safeguarding the next generation (ministry leaders and parents)

Survivor care

Training

Select Topic(s) – Jeff Dalrymple

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Template Topics Choices

For how many sessions are you requesting this speaker?(Required)

What type of session(s) are you requesting for this speaker?(Required)

(keynote, lecture, breakout, Q&A panel session, etc.)

For what length of time should the presenter prepare to speak for each session?(Required)

What time do you request the presenter arrive to the event location?(Required)

Request a second speaker?

Yes

Speaker 2 Information

Speaker Selection 2

2 Select Topic(s) – Thomas Jordan

Crisis Response

2 Select Topic(s) – Chris Atkins

Crisis response

Operations / Supervision

Training

2 Select Topic(s) – Emily Smith

Abuse Prevention & Response Foundations

Safeguarding the next generation (ministry leaders and parents)

Screening

Training

Child Safety Coordinator

Grooming

Developing Policies and Procedures to Protect the Vulnerable

2 Select Topic(s) – Amber Privett

Abuse Prevention & Response Foundations

Caring well / Church cares

Crisis response

Grooming

Response plans

Survivor care

Training

2 Select Topic(s) – Lynne Little

Abuse Prevention & Response Foundations

Safeguarding the next generation (ministry leaders and parents)

2 Select Topic(s) – Davis Younts

2 Select Topic(s) – Kris Buckman

2 Select Topic(s) – Keith Myer

Abuse Prevention & Response Foundations

Governance

Training

Caring well / Church cares

Survivor care

Leading Change as a Pastor

The Role of the Associational Leader Leading Without Controversy

State Convention Level Change

2 Select Topic(s) – Brad Eubank

2 Select Topic(s) – John Murphy

Abuse Prevention & Response Foundations

Crisis response

Governance

Risk management / insurance

Screening

Training

2 Select Topic(s) – Sara Robinson

Abuse Prevention & Response Foundations

Caring well / Church cares

Grooming

Safeguarding the next generation (ministry leaders and parents)

Training

2 Select Topic(s) – Jenny Estrada

Abuse Prevention & Response Foundations

Child Safety Coordinator

Safeguarding the next generation (ministry leaders and parents)

Screening

2 Select Topic(s) – Manny Keyser

Abuse Prevention & Response Foundations

Caring well / Church cares

Crisis response

Safeguarding the next generation (ministry leaders and parents)

Survivor care

Training

2 Select Topic(s) – Jeff Dalrymple

For how many sessions are you requesting this speaker?

What type of session(s) are you requesting for this speaker?

(keynote, lecture, breakout, Q&A panel session, etc.)

For what length of time should the presenter prepare to speak for each session?

What time do you request the presenter arrive to the event location?

Request a third speaker?

Yes

Speaker 3 Information

Speaker Selection 3

3 Select Topic(s) – Thomas Jordan

Crisis Response

3 Select Topic(s) – Chris Atkins

Crisis response

Operations / Supervision

Training

3 Select Topic(s) – Emily Smith

Abuse Prevention & Response Foundations

Safeguarding the next generation (ministry leaders and parents)

Screening

Training

Child Safety Coordinator

Grooming

Developing Policies and Procedures to Protect the Vulnerable

3 Select Topic(s) – Amber Privett

Abuse Prevention & Response Foundations

Caring well / Church cares

Crisis response

Grooming

Response plans

Survivor care

Training

3 Select Topic(s) – Lynne Little

Abuse Prevention & Response Foundations

Safeguarding the next generation (ministry leaders and parents)

3 Select Topic(s) – Davis Younts

3 Select Topic(s) – Kris Buckman

3 Select Topic(s) – Brad Eubank

3 Select Topic(s) – Keith Myer

Abuse Prevention & Response Foundations

Governance

Training

Caring well / Church cares

Survivor care

Leading Change as a Pastor

The Role of the Associational Leader Leading Without Controversy

State Convention Level Change

3 Select Topic(s) – Manny Keyser

Abuse Prevention & Response Foundations

Caring well / Church cares

Crisis response

Safeguarding the next generation (ministry leaders and parents)

Survivor care

Training

3 Select Topic(s) – Sara Robinson

Abuse Prevention & Response Foundations

Caring well / Church cares

Grooming

Safeguarding the next generation (ministry leaders and parents)

Training

3 Select Topic(s) – Jenny Estrada

Abuse Prevention & Response Foundations

Child Safety Coordinator

Safeguarding the next generation (ministry leaders and parents)

Screening

3 Select Topic(s) – Manny Keyser

Abuse Prevention & Response Foundations

Caring well / Church cares

Crisis response

Safeguarding the next generation (ministry leaders and parents)

Survivor care

Training

3 Select Topic(s) – Jeff Dalrymple

For how many sessions are you requesting this speaker?

What type of session(s) are you requesting for this speaker?

(keynote, lecture, breakout, Q&A panel session, etc.)

For what length of time should the presenter prepare to speak for each session?

What time do you request the presenter arrive to the event location?

Request a fourth or more speaker(s)?

Yes

Submit this form and contact [email protected] if you’d like to request more than three speakers.