Name
*
First Name
Last Name
Email
*
Best number we can reach you at:
*
(###)
###
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Will your spouse be attending with you?
Will your children be attending with you?
Please tell us some things you enjoy (drinks, snacks, hobbies, etc.), as well as, any dietary needs or food allergies you may have:
Assistant's Name
First Name
Last Name
Assistant's Email
Assistant's Office Phone Number
(###)
###
####
Assistant's Cell Number
(###)
###
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Will you have additional guest(s) attending with you?
*
If yes, how many?
How will you be arriving to our area?
*
Please email your itinerary and invoice as soon as it is available to ksmith@radiantjxn.com, including reimbursement information.
Will you need hotel accommodations during your stay?
*
How many days will you be staying in our area?
*
How many nights will you be staying in our area?
*
Please tell us your lodging preferences. We will do our best to accommodate you with what you request or an equivalent.
*
Will you be renting a car during your stay?
*
Please email or provide a copy of the invoice as soon as it is available to ksmith@radiantjxn.com, along with reimbursement information.
What is your shirt size?
*
Will you be bringing product or merchandise with you?
How many tables will you require for displaying/selling your product?
Will you require someone from Radiant to run the sales of your table?
What forms of payment will you accept?
If accepting checks, who will they be payable to?
Do you have your own point of sales system such as an iPad, square account and reader?
What will your message title be?
Do you have pictures or videos that you would like displayed?
Check all that apply
Name of person in charge of your media
First Name
Last Name
Email
Phone
(###)
###
####
Microphone Preference
*
Stage Needs:
*
Please communicate any other needs you may have below.
I authorize Radiant Church to use my name, voice, likeness and biographic information for any promotional purpose and for publication on the internet. I warrant that the presentation and any written or verbal material I submit are original, that their publication will not infringe on the rights of others, and that I have full power to grant this license. If my presentation or written materials required permission for use, I have obtained written permission from the copyright proprietor. I grant Radiant Church a perpetual, royalty-free worldwide license to use, copy modify, Publicly display, publicly perform, broadcast and distribute in any format, including without limitation via the internet, intranets, CD-ROM and other technologies, the materials and your presentation of the materials. Therefore, I acknowledge that Radiant Church owns all rights to use recordings (tape and digital) and its written transcription for Radiant Church's own purposes and to distribute recordings and its written transcription in any medium, including in electronic format via the internet. I understand that this release in no way prohibits me from using my own material in any manner I so desire.
*
PLEASE SIGN AND DATE BELOW:
Date
*
MM
DD
YYYY
