Speaker Request Form

SPEAKER REQUEST FORM
SPEAKER(S)*

Tony GuruleChristine CareyMike WesterfieldOlin ("O.G.") Giles
ALTERNATE SPEAKER(S)

Tony GuruleChristine CareyMike WesterfieldOlin ("O.G.") Giles
About You
Please tell us a little bit about you and your organization.
______________________________________________________________________________________________
YOUR ORGANIZATION*
ORGANIZATION'S WEBSITE
YOUR NAME*
YOUR EMAIL*
Type carefully so we can email you back.
SECONDARY EMAIL
PHONE*
About the Event
Please tell us about your event.
______________________________________________________________________________________________
EVENT DATE*

MonthDayYear
Date
ALTERNATE DATE (IF ANY)

MonthDayYear
Date
NAME OF VENUE*
TYPE OF EVENT (select one or more)*

SermonConferencePresentationTraining Event / Seminar
LOCATION OF THE EVENT*

Street Address Line 2
EXPECTED ATTENDANCE*
NUMBER OF SPEAKING TIMES*
INTENDED HONORARIUM*
ARE YOU WILLING TO PAY TRAVEL EXPENSES?*

YesNoMaybe (depends on the cost)
EVENT DESCRIPTION*
MAY WE SELL RESOURCES AT THE EVENT?*

YesNo
WILL YOU BE CHARGING PEOPLE TO ATTEND THE EVENT?*

YesNo
ARE YOU A HUMAN?*
If you have any issues submitting the form then please email your request to info@radicaltruth.net
*** When necessary, due to security concerns, we may require additional information and may also use the information provided to consult with law enforcement. ***
Should be Empty: