(* fields are required)

Name of Church/Organization *

Contact Person *

Cell Number *

Email *

Date of event *

RITA IS ONLY BOOKING EVENTS SUNDAY EVENINGS, MONDAYS, TUESDAYS, AND THURSDAYS. (NO WEEKEND DATES BEGINNING MAY, 2027)

Time of event *

Theme or Topic for event *

Number of times to speak *

Estimated Attendance *

Location and physical address of event (for GPS use please) *

Are you willing for this information to be placed on my website *

Please fill out all of the information below.

Thank you!

Check the mileage from 1511 Cainwood Street Amory, MS 38821 to your event location.

DOUBLE THE MILES FOR ROUND TRIP and figure at 76 cents per mile.

Total reimbursement will be *

Honorarium amount in addition to travel will be *

*If overnight, please reflect the amount of extra time spent on my behalf as you determine the honorarium amount.

*The reimbursement and honorarium MUST be provided AT THE EVENT, please.

I agree to the above (enter your name) *