Speaker Request

Speaker Request

Please complete this form as thoroughly as possible.

Event Details

Event Name*

Preferred Event Date*

Optional Event Dates

Providing optional event dates, if available, helps us better accommodate your request and ensure scheduling flexibility.

Event Website

Event Format*

Select

Venue Name*

Venue/Event Address*

Please provide street address, city, and state.

Brief Event Description*

Expected Audience Size*

Exhibiting Booth Option*

Select

Presentation Details

Preferred Speaker*

Select

Desired Topic*

Desired Outcome of Speaking Engagement*

Number of Presentations*

Length of Presentation(s)*

Please provide length of presentation in minutes. (e.g. 30 Minutes, 90 Minutes)

Requestor Contact Information

What is your first and last name?*

Title/Position*

Email Address*

Phone Number*

Phone

Organization Name*

Organization Website*

Church/Denomination Connection

If your organization is affiliated with a church or denomination please provide details.

Request a Response By?

Please indicate the date by which you would like to receive a response to this request. We'll do our best to accommodate your timeline.

Proposed Budget for Expenses & Honorarium

Please provide your proposed budget. While we have a professional fee structure in place to cover the costs associated with the preparation and participation in speaking engagements, we will consider your proposed budget. Our final quote will be based on the details and location of your event.

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