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POT REQUEST FORM
Name
(Required)
Email
(Required)
Market
(Required)
OKC
Tulsa
Claremore, OK
Wichita
Crystal Coast, NC
Greenville, NC
Kansas City
Colorado Springs
DFW
Weatherford
Resident presence needed
(Required)
Male
Female
Both
Total Residents Requested
Does a resident need to share testimony on stage?
(Required)
Yes
No
Do you need a male or female speaker? - How long will they have to speak?
How many POT staff members are needed?
(Required)
Will you be personally in attendance? If not, who from your team will be present?
(Required)
Date
(Required)
MM slash DD slash YYYY
Time start (if more than one shift is needed, please specify at the bottom)
(Required)
Time end
(Required)
Location
(Required)
Please enter address
Will Lance Lang be speaking/attending?
(Required)
Yes
No
Additional Notes
