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*