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Deaconess Foundation Event Participation Request Form
If interested in requesting the participation of Deaconess Foundation's President and CEO in an upcoming event, please complete the fields below and submit the form for consideration. Thank you!
Date of Event
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Event's Beginning and Ending Time
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Nature of Request (meeting presentation, keynote speaker, panelist, moderator, award recipient, preacher, other)
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Requested Arrival Time
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Name of Host Institution
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Event Name/Theme:
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Topic and/or Agenda
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Anticipated Outcome
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Time Keynote/Address/Sermon will begin
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Requested Length of Presentation (e.g. 20 min. remarks)
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Please provide a detailed description of requested subject matter. List any key points or issues you would like to be addressed.
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Please list additional speakers/panelists on the program, if applicable.
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Anticipated audience (i.e. projected attendance, affiliations, demographics):
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Recommended attire
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Will press be present at event? If so, please list:
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Event Location with address
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Name of person submitting request
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Contact email
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Daytime cell phone contact number
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Name of contact person for logistics
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Contact email
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Name of contact person for content
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Contact email
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Will an honorarium be provided? If yes, please provide offer amount. (Acceptance of an invitation is not based on the host's ability to pay).
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Provisions of accommodations, if lodging is required outside of the St. Louis region.
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Provisions of travel expenses, if travel is required outside of the St. Louis region (i.e. flight, ground transportation, meals etc.)
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Will the event be recorded? If so, will organization provide link of copy of the recording?
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