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

Please provide as much detail as possible.

Date of Submission*
MM slash DD slash YYYY
Date of Event*
Event's Beginning and Ending Time, Please Include Time Zone*
Nature of Request*

(meeting presentation, keynote speaker, panelist, moderator, award recipient, preacher, other)
Requested Arrival Time*
Name of Host Institution*
Name and/or Theme*
Topic and/or Agenda*
Anticipated Outcome*
Time Keynote/Address/Sermon will begin*
Requested Length of Presentation*

(e.g. 20 min. remarks)
Please provide a detailed description of requested subject matter. List any key points or issues you would like to be addressed.*
Please list additional speakers/panelists on the program, if applicable.*
Anticipated audience*

(i.e. projected attendance, affiliations, demographics)
Will press be present at event? If so, please list:*
Event Location with address*
Recommended attire*
Name of person submitting request*
Contact email*
Daytime cell phone contact number*
Name of contact person for logistics*
Contact email*
Name of contact person for content*
Contact email*
Will an honorarium be provided? If yes, please provide offer amount.*

(Please note: Dr. Wilson’s standard speaking 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.)
Provisions of accommodations, if lodging is required outside of the Washington, DC region.*
Provisions of travel expenses, if travel is required outside of the Washington, DC region.*

(i.e. flight, ground transportation, meals etc.)
Will the event be streamed live OR will a recording be available online?*
- Yes
- No
Please specify which (streamed live or recording available online):
Please provide a link to where the live event or recording will be available:
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 provide a link to a 1600 x 900px graphic that 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.*
Comments
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CDF Event Participation Request Form for Rev. Dr. Starsky Wilson

Please provide as much detail as possible.

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