Evangelism Speaker Request
Step
1
of
11
9%
Which Speaker would you like to request for your event?
(Required)
Shane Pruitt
Paul Worcester
Tim Dowdy
JJ Washington
Catherine Renfro
Name
(Required)
First
Last
Email
(Required)
Your Work Phone Number:
Your Cell Phone Number:
(Required)
Are you the primary contact for this event?
(Required)
Yes
No
Event Contact Name
(Required)
First
Last
Event Contact Email
(Required)
Event Contact Work Phone Number
Event Contact Cell Phone Number
(Required)
Church or Organization Name:
(Required)
Event Name:
(Required)
Event Theme:
(Required)
Event Start Date:
(Required)
Event End Date:
(Required)
Purpose and Vision of Event:
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Event Description:
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Event Website (If applicable):
Target Audience:
(Required)
Estimated Attendance:
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Location of Event:
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Street Address
City
Alabama
Alaska
American Samoa
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Guam
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Northern Mariana Islands
Ohio
Oklahoma
Oregon
Pennsylvania
Puerto Rico
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
U.S. Virgin Islands
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Armed Forces Americas
Armed Forces Europe
Armed Forces Pacific
State
ZIP Code
Recommended Nearby Airport:
(Required)
Distance from Airport to Event: (miles)
(Required)
How many sessions would you like for this speaker to speak at?
(Required)
Specific Speaking Time(s):
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Duration of Speaking Time(s):
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Session Topics: (Please give as much detail as possible)
(Required)
What is appropriate attire for this event?
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When do you expect the speaker to arrive at this event? (Date + Time)
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When are the speaker's official obligations complete for this event? (Date + Time)
(Required)
Will the speaker need to send slides ahead of time? If so, please include a due date as well as the contact to send them to.
(Required)
Is a promotional video needed for social media or a website or newsletter?
(Required)
No
Yes
The speaker occasionally travels with family or staff member. Would this be a problem?
(Required)
No
Yes
Are there any meetings/commitments you would like the speaker to be part of prior to or during the event?
(Required)
Is there an opportunity for the speaker to sell relevant resources and merchandise? If so, they will need a table and volunteers to assist.
(Required)
Yes
No
Is the speaker the Primary speaker for this event?
(Required)
Yes
No
If applicable, please list other speakers who are committed to speak at this upcoming event.
Is there anything else you would like to share about this event?
When do you need an official response from the speaker for this event?
(Required)
