Soul Shop™ and ASIST Request Form

Request form for Soul Shop™ and ASIST workshops.

Thank you for taking a few moments to fill out this request form for your upcoming Soul Shop or ASIST. This will place your workshop into our queue so we can ensure you have all the resources to be successful.

When filling out this form, please provided us with as much information as you are able.

Thank you,

Soul Shop Team

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

Your Name:

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* 2. Day of event contact

I am the contact person

Other (please specify)

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* 3. Company, Church, or Organization:

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* 4. Street Address?

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* 5. City, State, Zip Code

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* 6. Email Address

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* 7. Phone Number

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* 8. How are we contracting this Soul Shop?

I will be contracting with Soul Shop directly.

I will be contracting directly with the trainer.

Other (please specify)

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

Please fill this form out for each of your events.

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* 10. 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 Hispanic Churches (8-hour program for Hispanic leaders and presented in Spanish only )

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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* 11. Event Date

Date

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

Start Time

Time

AM/PM

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* 13. Time Zone:

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

No. Private event

Yes. Open to the community

Not sure.

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* 15. Location of the event.

Location

Address

Address 2

City/Town

State/Province

ZIP/Postal Code

Phone Number

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

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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 Soul Shop is NOT creating your registration page and you are creating your registration page for your event, please provide us with the registration link so we can add it to the Soul Shop™ website. This is one of the most important things you can do to help funnel attendees to the right spot.

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