Booking Request Form for Stephanie Kirkland
Your Name *
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Contact Name *
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Organization Name *
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Event Address *
Street Address *
Address Line 2
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Postal / Zip Code *
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Phone Number

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Email
Website
Type of Event *
 Women's Conference 
 Women's Retreat 
 Business Conference (unisex) 
 Workshop/Training 
 Panel 
 Worship Service 
 Faith based event 
1st Date Requested *

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Optional Date Requested

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Event Details
1. What is the theme?
2. What is the purpose of the event?
3. What are the theme colors?
4. Who is the audience?
4. How many will be in attendance? *
Speaker Details
1. What is the speaker budget?
2. What is the timeframe you want Dr. Kirkland to speak (time, days, etc) *
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