Speaker Request Form for Executive Director
Speaker Request Form for Executive Director
SPEAKER REQUEST FORM
ORGANIZATION NAME AND LOCATION
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CONTACT INFORMATION
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CONTACT INFORMATION
First Name
First Name
Last Name
Last Name
EMAIL
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PHONE NUMBER
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DATE(S) OF EVENT
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TIME OF EVENT
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LOCATION OF EVENT
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PURPOSE OF EVENT
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THEME/THEME SCRIPTURE (If Applicable)
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IN WHAT WAY(S) WOULD YOU LIKE TO INVITE THE EXECUTIVE DIRECTOR TO PARTICIPATE IN THIS EVENT?
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Preach
Facilitate Workshop
Keynote Speaker
Teach Bible Study
Give Remarks/Greeting
Other
Other: (Explain)
LENGTH OF PRESENTATION (Please indicate in time and/or days)
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WILL TRAVEL EXPENSES ASSOCIATED WITH THE EXECUTIVE DIRECTOR'S PARTICIPATION BE COVERED? (Flight, Hotel, Mileage, Rideshare and/or Rental Vehicle)
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Yes
No
HONORARIUM AMOUNT
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WILL THERE BE AUDIO/VISUAL CAPABILITIES TO SHARE MUSIC, VIDEOS, POWERPOINT, ETC.?
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Additional Information:
DISCLOSURE
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