CDF Event Participation Request Form for Rev. Dr. Starsky Wilson

Please provide as much detail as possible.

"*" indicates required fields

Form submission date*

Event date*

Event start and end times (please specify time zone)*

Nature of request*

(Ex. meeting presentation, keynote speaker, panelist, moderator, award recipient, preacher, etc.)

Requested arrival time*

Name of host institution*

Event name and/or theme*

Topic and/or agenda*

Anticipated outcome*

Time keynote/address/sermon will begin*

Requested length of presentation*

(E.g. 20-minute speech)

Please provide a detailed description of the requested subject matter. List any key points or issues you would like Rev. Dr. Wilson to address.*

Please list additional speakers/panelists on the program, if applicable.*

Anticipated audience*

(I.e. projected number in attendance, audience affiliations, and/or audience demographics)

Will press be present at event? If so, please list:*

Event location with address*

Recommended attire*

Your name*

Your email*

Daytime cell number*

Name of contact for event logistics*

Logistics contact email*

Name of content contact*

Content Contact Email*

Will an honorarium be provided? If yes, please provide offer amount.*

(Please note: Rev. Dr. Wilson’s standard speaker fee is $2,500–$10,000, though acceptance of an invitation is not based on the host’s ability to pay. Highest consideration is given to invitations that are values-aligned and provide opportunities to inform Dr. Wilson’s mission by directly engaging children and youth.)

Accommodations details (if lodging is required outside of the Washington, D.C. region):*

Provisions for travel expenses (if travel is required outside of the Washington, D.C. region):*

(Ex. flight, ground transportation, meals, etc.)

Will the event be livestreamed or will a recording be made available online?*

Livestreamed only

Recorded only

Livestreamed and recorded

This event will not be livestreamed or recorded.

Do you grant Children’s Defense Fund permission to use video(s) and photos produced of Dr. Wilson, by your organization, at your event, for CDF’s future use?*

Yes

Please provide a link to where the live event or recording will be available (if applicable):

Will there be a cost associated with viewing the event?

If you would like us to promote Rev. Dr. Wilson’s participation in the event, please upload a 1600px x 900px graphic we can use on our social channels (optional):

Accepted file types: jpg, gif, png, Max. file size: 200 MB.

Name and email address for point of contact to coordinate promotion, if necessary:

Please share information on your COVID-19 safety protocols.*

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