Contact Name

Name of Church or Event

Contact Phone Number

Contact E-Mail Address

Event Start Date

Event End Date

Address Of the Event (Include Venue Name if applicable)

Speaking Topic

Describe the Audience (Size, Age, etc...)

What do you want your audience to take away from this event?

Is the event filmed? Is the event filmed? Yes No

Accommodations for Speaker Accommodations for Speaker Lodging Provided Meals Provided Travel Arrangements Provided Travel Reimbursed (if not provided) AV Provided Wi-Fi at Venue

What is your budget for a speaker?

Is there anything else JC should know about this event?