Speaking Information Request

IMG_1995I’m pleased that you’re considering having me speak at your event! Please fill out and submit the form below. I’ll review all of your information and be in touch with you soon.

Please note: By submitting this form, you are NOT obligated in any way. This is simply a free inquiry! I’ll contact you by email with more information, a quote that covers fees and expenses, and details of how to proceed when you’re ready.

    Your Information

    Email Address (required)

    Your Name (required)

    Mailing Address

    City

    State

    Zip Code

    Daytime Phone

    Evening Phone

    Best Time to Call:
    Morning (9am-12pm)Afternoon (1pm-5pm)Evening (7pm-9pm)

    About Your Event

    Name of Event

    What is the name of the church or organization?

    What is your title or position, if any?

    Event Location (City/State):

    Preferred Date of Event:

    Second Choice Date of Event (if any):

    Please indicate what type of program you are interested in:
    Leadership TrainingLeadership RetreatTeacher TrainingChurch GrowthRevivalMen's RetreatOther*

    *Other:

    Is there anything else you want us to know about your event?

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