SPEAKER REQUEST FORM

Name of Event/Church/Organization *

Contact Name *

Contact Name

First Name

Last Name

Contact Phone Number *

Contact Phone Number

(###)

###

####

Email Address *

Website

http://

Speaking Location Address *

Speaking Location Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

How did you hear about Lee Domingue?

If applicable please explain.

Event details

Expected Attendance *

Date(s) and Time(s) of Speaking Engagement *

Specific Topic *

Target Audience *

Time Allotted *

Speaker Attire *

Event Attire *

Media

Upon event conclusion, please send two copies of Videos (DVDs) & Audio recordings to:

Kingdom Builders U.S.

3660 Grandview Parkway, Suite 100

Birmingham, AL 35243

A/V Contact

First Name

Last Name

Phone Number

(###)

###

####

Please choose facility capabilities (select all that apply)

Lee request a wireless microphone headset if possible for use at the event.

Audio Lapel Mic

Audio Handheld Mic

Audio Headset Mic

Powerpoint, DVD, and Video

Resources

Resource Contact

First Name

Last Name

Phone Number

(###)

###

####

May we display and sell our product at the event?

Yes

Can you provide a volunteer to manage the product table?

Yes

Book Cost

01 TO 20 - $20 PER BOOK

21 AND UP - $15 PER BOOK (Use Promo Code: "POTK")

Purchase Here

If you would rather be invoiced, how many books would you like to purchase?

Product Shipping

Product shipped for arrival approximately one (1) week prior to event.

Buyer to pay shipping cost

Product Shipping Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Speaking Honorarium / Offering

A CUSTOMARY HONORARIUM GUIDE IS $5,000 PER EVENT. ALL MONIES RECEIVED GO TO FURTHER THE WORK OF KINGDOM BUILDERS U.S. AND IT'S ANTI-HUMAN TRAFFICKING CAMPAIGN "TRAFFICKING HOPE". PLEASE EMAIL US AT: INFO@KINGDOMBUILDERS.US IF YOU HAVE ANY QUESTIONS.

Please make checks payable to:

Kingdom Builders U.S. (Tax ID # 26-0275707)

3660 Grandview Parkway, Suite 100

Birmingham, AL 35243

Arrival Process

1. Standard arrival time is 1 hour before the start of the event.

2. Upon arrival, please inform Lee of any AV or Soundcheck arrangements that need to be made.

3. If possible, Lee would like the opportunity to meet Pastors/Leaders before the start of the event in order to pray with them.

Arrival Contact *

Arrival Contact

First Name

Last Name

Phone Number *

Phone Number

(###)

###

####

Email *

Nearest Commercial Airport *

Logistics

Unless prior arrangements have been made, we prefer to book travel and provide an invoice for reimbursement for Lee and a travel companion upon booking . In most cases, Lee will have a travel companion. All travel expenses to include all modes of transportation and associated costs, meals, mileage, and hotel accommodations.

Domestic airfare will be booked as coach class. Cross Country and International travel airfare will be booked as business class.

Speaker requests bottled water in Greenroom.

Questions or need assistance? Please contact us at: events@kingdombuilders.us