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First Name*
Last Name*
Email
Address
City State / Province / Region ZIP / Postal Code
My organization is a*
Name of Organization [if applicable]
Date Of Appearance
Date*
Date Format: MM slash DD slash YYYY
Time*

: HH

MM
Do you plan to have any other speakers at your event?*
- Yes
- No
If yes, how many? Will this be a panel discussion or individual presentations?
Time

: HH

MM
Time

: HH

MM
Event Address
City State / Province / Region ZIP / Postal Code
Tell Us About Your Event:
Please Read
1) Straight Street Life Center is grateful for the opportunity to share this important topic with your organization.
2) All requested dates will be confirmed via email.
3) It is appreciated when the organization requesting a speaker will cover all travel related expenses.
4) The offering check should be made payable to Straight Street Life Center, Inc. and sent to:
  12461 Veterans Memorial Hwy
     Douglasville, GA, 30134
6) Four weeks advanced notice appreciated.
Estimated crowd/gathering size:*
Have You Requested a Speaker Before?*
- Yes
- No
- Not Sure
TAX DEDUCTIBLE
Straight Street Life Center, Inc. is a 501 (c)(3) non-profit organization that relies on the generosity of our partners and community to ensure we will always be there for girls in need. Your financial investment supports our programs, operating expenses, and the continuation of reaching other cities in the fight for freedom and restoration. Your donations are tax-deductible.