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