Soul Shop™ and ASIST Request Form

Once this form is completed, It will be sent to the Soul Shop™ offices. We will be in touch over the next few days.

Participants packets have increased. Please contact your trainer for pricing.

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* 1. Hosts information: ( This address is where the contract will be sent).

Name

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* 2. Company

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* 3. Street Address?

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* 4. City, State, Zip Code

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* 5. Email Address

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* 6. Phone Number

Please fill this form out for each of your events.

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* 7. Type of event you are hosting:

Soul Shop™ For Leaders (8 hour program for general leaders in the church)

Soul Shop™ for Black Churches (8 hour program for Black leaders in the church)

Soul Shop™ for Youth Leaders (8 hour program for youth pastors, youth leaders and Campus leaders)

Soul Shop™ for Communities (1 1/2 hour program for general information about suicide)

Applied Suicide Intervention Skills Training - ASIST (2 Day Workshop)

Other (please specify)

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* 8. Day of event contact

I am the contact person

Other (please specify)

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* 9. Who is the Trainer? (Please leave blank if you do not know)

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* 10. Is this workshop open to the public or private event?

No. Private event

Yes. Open to the community

Not sure.

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* 11. Do you have the location for your event? If yes, please fill out the location information. '

Yes

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* 12. Location of the event.

Company

Address

Address 2

City/Town

State/Province

ZIP/Postal Code

Phone Number

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* 13. Can you provide specific information about how to navigate the location of the event?

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* 14. Event Date

Date

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* 15. Event Start Time ( 8:30am - 4:30 pm is recommended)

Start Time

Time

AM/PM

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* 16. Time Zone:

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* 17. What is the maxium number of attendees for this event?

100

Clear

i We adjusted the number you entered based on the slider’s scale.

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* 18. Lunch is mandatory for all events over 4 hours. Will your organization be providing any of the following?

Water

Coffee

Soda

Snacks

Breakfast

Other (please specify)

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* 19. Would you like Soul Shop™ to create the registration page for your event on EventBright?

Yes

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* 20. If you are creating your own personal registration page for your event, could you please provide us with the registration link so we can add it to the Soul Shop™ website?

If your answer for question #18 is "No", please skip ahead to the bottom of this page and press "DONE"

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* 21. Would you like to have a wait list for this event?

Yes

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* 22. Are there sponsors you would like to include in the registration page?

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* 23. Last day to register for your event:

Date / Time

Date

Time

AM/PM

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* 24. Will there be a charge to attend this event?

Yes

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* 25. If Yes, How much do you want to charge attendees for this event?

No Fees

$395

Clear

i We adjusted the number you entered based on the slider’s scale.

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* 26. Would you like to provide a promo code for attendees?

50% off

Free

Other (please specify)

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* 27. There is a 3.5% + $1.59 fee with Event Bright per ticket sold and 2.5% processing payment fee per order. Would you want the Attendee or your organization to pay this fee?

Attendee

Your Organization

There will not be a charge for attending this event

Please contact Christopher@soulshopmovement.org to make your deposit. If you are contracting with a particular trainer, please contact your trainer to make payment arrangements. If you are unsure, please contact your trainer directly. Also, this information should be located on the first page of the contract you received.

Please return to this page and complete the form with the "DONE" button at the bottom of this page. (Information will not be sent until this form is complete).