Speaking Engagement Request

Speaking Engagement Request

To request Dr. Joe Samuel Ratliff for a speaking or preaching engagement, please complete the following form. Please note that this is a request for information and should not be considered a confirmation of his acceptance. Once your form is received, you will be contacted by LaPorsche Thomas, Executive Assistant to the Pastor within 1 week regarding your request. Thank you in advance for your invitation.
Email
Event Name
Date of Speaking Engagement

MonthDayYear
Time of Speaking Engagement

:HourMinutesAM/PM Option
Location of Speaking Engagement

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Brief Description of Event and Its Purpose
Church/Organization Name
Church/Organization Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Phone Number

Area CodePhone Number
Fax Number

Area CodePhone Number
Website
Senior Pastor/Host Name
Day Phone

Area CodePhone Number
Cell Phone

Area CodePhone Number
Contact Person Name
Office Phone

Area CodePhone Number
Cell Phone

Area CodePhone Number
Fax Number

Area CodePhone Number
Email
Should be Empty: