Come Clean Entertainment Booking Form

Darryl Wheeler Sr.


E-mail to:


Today's Date: _________________            

Your Organization:  _____________________________________________

Event coordinator:______________________________________


Home number: ______________________________ 

Work number:  ________________________________


Cell Number: _________________________________


Fax:____________________________ Will you need a cover sheet? (yes or no)


Email address: ___________________________________________________



Activities Requested:   please circle or check off your needs


       Motivational speaker (a specific speech)

       Youth and Family Seminar Series

       Minister (the Word of God)

       General Empowerment Workshop (For anyone: Church, Corporate, Organizations or Private Engagements)

       DVD signing and “Meet and greet”





Event Name /Theme or Special Colors:_____________________________________________ 

Location (Name of Building/Hotel/Center- City , State and Zip Code) and ADDRESS please:


BUILDING’S NAME:_____________________________________________________________

STREET ADDRESS:             



Is it an indoor or outdoor event?____________________________________


DAY and Date of Event: DAY:__________DATE: ________________ Time: __________


Type, Gender and Age Range of audience:_____________________________________


What is your expected attendance?:________________________________


What is the attire for your occasion?____________________________________________


Duration of speech or workshop:______________________________   


Your Org. Website address:____________________________________________


Reason for Event:







Is it FREE and open to the public?_______________


How much are the tickets or registration fee and who can they contact to get more info?




What is your speaker budget or honorarium? (We go off of what YOUR existing budget is for

the speaker/artist that you requested? This amount should NOT include the speaker’s round trip airfare and hotel room if outside of Chattanooga TN. You must fill in an amount on this requested part. If this section is left blank, it’s considered inconsiderate to the speaker’s time and talent.




Thank you for your interest and for filling in all the blanks. We will get back to you as soon as

we receive your request. God bless you!

Note:  If outside of Chattanooga TN Mr. Wheeler travels his wife and an assistant. Please note that you will be responsible for airfare for his wife and assistant as well.