Speaker Request Form

Speaker Request Form
Your Name*

First NameLast Name
Your Contact Email*
example@example.com
Your Contact Phone Number
Name of Church or Ministry *
Church or Ministry Website*
Name of Requested Event or Conference*
Theme(s) and/or Focus of Gathering
Date of Event *

MonthDayYear
Date
Expected Number of Attendees*
Event Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Will an Honorarium be Provided? Pastor Corene will determine the amount based on the ministry engagement.*

YesNo
BOOKING REQUIREMENTS

To successfully book Pastor Corene, she requires that airfare be provided for herself and an assistant. If Pastor Geno accompanies her, she will require 2 airline tickets and 1 King 4 star hotel room.

If she travels with an assistant other than Pastor Geno, she requires 2 airline tickets and two King 4 star hotel rooms for her and her assistant.
Will Hotel and Travel Expenses be Provided?*

YesNo
Number of Speaking Sessions Requested*
Will There be a Vendor Table Available?*

YesNo
Additional Relevant Information or Requests
Should be Empty: