Name of Event:

    Date and Time of Event:


    Sponsored by:

    Sponsor’s Address/City/State:


    Host Organization’s Website:

    Contact's Name:



    Theme/Subject of my presentation:

    How many times will I speak and for how long?
    Please note: The cost you were quoted was based upon these guidelines:

    Brunch/luncheon: 1 session
    One-day retreat: 2 sessions
    Weekend retreat: 3 or 4 sessions

    If you require more sessions, please speak with me before filling out the online form. Thanks!

    I will be using a PowerPoint presentation. Will a projector/screen or large TV be available?

    Please indicate what multimedia will be provided. (projector, sound, etc.)

    When shall I arrive?


    Overnights provided on (dates):

    (Private room, please.)
    Breakfasts on (dates):

    Lunches on (dates):

    Suppers on (dates):

    Anticipated Number in Attendance:

    Is this women only, or women & men?

    General description of group (age, denomination, etc.) & any other pertinent information

    Photo can be taken off website. Would you also like for a jpg to be emailed to you for promotion materials?

    Speaking Honorarium agreed upon:
    $ includes travel expenses
    (please include amount so that we both can plan ahead)

    Please send me any promotional materials and the schedule for the event so that I may become familiar with you prior to arrival. (Last year’s brochure of the same event would also be helpful.)

    Either upload from computer:

    and/or link:

    Your name:

    Your email:

    Thanks for remembering me in your prayers! Kristi