Event Date *

MM

DD

YYYY

Multiple Dates *

Are you requesting Channing B. for multiple dates?

Yes

No

Event Time

Hour

Minute

Second

AM PM

Requested Services *

What role will Channing B. be playing at your event?

Speaker

Panelist

Host

On Screen Talent

Other (Please detail in the "Message" section below.)

Event Location *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Accommodations *

If this event is outside the Tulsa area, is your team prepared to provide travel and lodging?

Yes

No

Point of Contact Name *

First Name

Last Name

Point of Contact Cell Phone *

What number should we use in case we need to text you?

Country

(###)

###

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