National Directors Form - Nehemiah Alliance

NA52 Leader Information Form

Thank you for being part of the Nehemiah Alliance event: Sundown September 10, 2026 – Sundown All Saint’s Sunday November 1,2026––a historic assignment. We truly could not do this without you. As we unite to Rebuild. Restore. Renew. our nation through 52 days of prayer, fasting, and repentance, your leadership is helping mobilize believers across America for such a time as this. We are honored to serve alongside you.

Nehemiah reminded the people, “The joy of the Lord is your strength” (Nehemiah 8:10). May the Lord strengthen your hands for the work, give you wisdom for every step, and use your faithful obedience to leave a lasting spiritual legacy for generations to come. We believe God will do immeasurably more than we could ask or imagine.

Please complete all required fields so our team can properly prepare, coordinate communications, and honor your participation. By signing up, we ask that you commit to attending.

Full Name

Title/Role (e.g., Pastor, Director, Rep., Founder, etc.)

Phone Number

Organization/Ministry Name

Website (Write N/A if none)

Short Bio (please no more than 3 - 5 sentences)

Published Works (list any books you've authored or Broadcast & Media Platforms––television, podcast, radio, digital or streaming platforms you host, produce, or lead).

Social Media Handles (Write N/A if none available).

Lower Third Information

Please enter your name, title, and organization exactly as you would like them to appear on screen if your video is used in promotional or event materials.

Lower Third Name

Lower Third Title

Lower Third Organization

Are you willing to serve as a spokesperson for NA52 (news, TV, or radio)?

Yes No Maybe Other

If you selected “Other,” please explain:

Commitment Confirmation

I confirm my intent to attend in person or to participate in the Nehemiah Alliance event on October 31, 2026.

Yes No Other

If you selected “Other,” please explain:

Attendance

How do you plan on attending Nehemiah Alliance on Saturday, Reformation Day, 10/31/26?

In person at the National Mall Sending a 1 - 3 minute video for day-of-the event and will be attending at a streaming location I'd be available to pray at event at the National Mall Other

If you selected “Other,” please explain:

VIP Seating on Reformation Day, October 31, 2026

Would you like VIP seating at our event taking place at the National Mall?

Yes No Maybe

Strategic Partnership Organization:

Please check the box below if you are interested in receiving additional information about being a "strategic partner organization."

Yes Other

If you selected “Other,” please explain:

Media, Name, Image & Likeness Authorization:

By submitting videos, photos, audio recordings, logos, or other media, I grant Nehemiah Alliance permission to use, reproduce, edit, publish, distribute, and display these materials, along with my name, image, voice, likeness, title, organization, and submitted content, for promotional, educational, broadcast, livestream, social media, website, and other ministry-related purposes without additional compensation. I affirm that I have the authority to grant these permissions.

I agree. Other

If you selected “Other,” please explain:

Photo/Media Release:

I consent to NA52 using my name, image, and bio for event promotion and media purposes.

YES, I give my consent. NO, I do not give my consent.

Media Uploads

Headshot Upload (high resolution, professional photo). Upload up to 5 supported files. Max 10MB per file
Acceptable formats: jpg, webp, png, avif, jpeg, heic, heif

Professional Headshot Upload

Introductory Video

Participants attending in person should upload a 1–3 minute introductory video for possible use on October 31, 2026, at the National Mall.

Please record horizontally in a quiet, well-lit location. MP4 or MOV format is preferred.

Please name your file:
LastName_FirstName_IntroVideo.mp4

Upload Intro Video to Dropbox

Introductory Video Status

I uploaded my introductory video to Dropbox. I am not attending in person, so a video is not required.

NA52 Leader Information Form

Lower Third Information

Commitment Confirmation

Attendance

VIP Seating on Reformation Day, October 31, 2026

Strategic Partnership Organization:

Media, Name, Image & Likeness Authorization:

Photo/Media Release:

Media Uploads

Introductory Video

JOIN ★ PRAY ★ FAST ★ REPENT ★ INTERCEDE ★ REBUILD ★ RESTORE ★ STAND ★ SEEK GOD ★