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).

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

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

Yes

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* 16. Location of the event.

Company

Address

Address 2

City/Town

State/Province

ZIP/Postal Code

Phone Number

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

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

100

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

Yes

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* 21. If you are creating your own personal 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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* 22. Would you like to have a wait list for this event?

Yes

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

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* 24. Last day to register for your event:

Date / Time

Date

Time

AM/PM

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

Yes

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

No Fees

$395

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

50% off

Free

Please provide us with the code you would like to use.

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* 28. If Soul Shop uses Eventbrite for this registration and is charged, fees are associated with this event company. Soul Shop will place the cost on the site, and when the workshop is over, we will send you the final bill with the cost to attend minus the fees associated with each participant from Eventbrite. These fees can add up to about 5% of the ticket price. Don't hesitate to contact Christopher Epperson at Christopher @SoulShopMovement.org if you would like more details. Who would you like to absorb the cost of the registration fees?

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.

Thank you and someone will contact you over the next week.

God Bless -
Soul Shop Team

Send me a copy of my responses via email