Speaking Requests

    General Information

    I can be available for speaking opportunities - but I need some information.
    If you'd like me to MC or host your event please use the MC Requests form.

    * = required

    Name of Organization*

    Name of Contact Person*

    Contact Person's Email*

    Assistant's Name

    Assistant's Email

    Contact Phone Number*

    Speaking Information

    Event Name*

    Date of Event* (YYYY-MM-DD)

    Multiple Dates

    Purpose of Event*

    Length of Session (45 min, 75 min, 8 hrs, etc.)*

    Speaking Topic*

    Estimated Number in Attendance*

    Audience Profile (Leaders, Pastors, Students, Harlequins, etc*


    Typical Budgeted Honorarium for This Event*

    Previous Speakers at Your Event*

    Additional Notes

    Travel Information

    Location and Address of Event Site*

    Distance From Airport to Speaking Location*