Speaking Request Form

Please note: Completing this form is for informational purposes only. By submitting this form, you are requesting that I consider your event, but I am not committing myself to serving your organization. Thanks for your understanding!

Name:
Address:
Phone Number:
Fax Number:
Email Address:
Best time to contact you:

(your time zone) Eastern Central Mountain Pacific
Event Location:
(Venue, City and State)
Event Dates:
(Already set or still flexible?)
Event Name:
Host Organization/Church:
Website (if available):
Denomination:
Doctrine/Statement of Faith:

(Tell me a little about the
host’s doctrines/statement
of faith)
General Event Description:

(goals/purposes, general
atmosphere, formal/informal)
Expected Number of Attendees:
Attendee Description:

e.g., Christian/non-Christian,
mature believers/leaders or seekers,
men/women/mixed group
By what date do you need to know
whether or not I can speak at your event?
Desired Number and Length of Teaching Sessions:
Financial Considerations:

Are you able to cover my expenses?
Do you anticipate being able
to provide an honorarium? If so,
what amount (or range)?
Nearest Airport:

What airport will I fly into for your event?

And how far away is your event from the airport?
How you heard about me:
Standard or Custom Event:

Are you asking for one of my standard events? Or is
this a custom event request? If custom, please
give details on the topics you’d like me to cover.
Please also note that my schedule does not
allow me to accept many custom events.
Other Information:

Is there anything else I need
to know about this event?