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Speaking Engagement Request Form
Thank you for considering Sergio Nazir Chavez for your Speaking Engagement! Please fill out and submit this form.
22
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1
Name of the organization and/or event
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2
Organization and/or event website
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3
Is this request for a virtual or in-person event?
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What date(s) are you requesting?
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5
Organization or Event address
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Uruguay
Uzbekistan
Vanuatu
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Venezuela
Vietnam
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United States
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Afghanistan
Albania
Algeria
American Samoa
Andorra
Angola
Anguilla
Antigua and Barbuda
Argentina
Armenia
Aruba
Australia
Austria
Azerbaijan
The Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bermuda
Bhutan
Bolivia
Bosnia and Herzegovina
Botswana
Brazil
Brunei
Bulgaria
Burkina Faso
Burundi
Cambodia
Cameroon
Canada
Cape Verde
Cayman Islands
Central African Republic
Chad
Chile
China
Christmas Island
Cocos (Keeling) Islands
Colombia
Comoros
Congo
Cook Islands
Costa Rica
Cote d'Ivoire
Croatia
Cuba
Curaçao
Cyprus
Czech Republic
Democratic Republic of the Congo
Denmark
Djibouti
Dominica
Dominican Republic
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Ethiopia
Falkland Islands
Faroe Islands
Fiji
Finland
France
French Polynesia
Gabon
The Gambia
Georgia
Germany
Ghana
Gibraltar
Greece
Greenland
Grenada
Guadeloupe
Guam
Guatemala
Guernsey
Guinea
Guinea-Bissau
Guyana
Haiti
Honduras
Hong Kong
Hungary
Iceland
India
Indonesia
Iran
Iraq
Ireland
Israel
Italy
Jamaica
Japan
Jersey
Jordan
Kazakhstan
Kenya
Kiribati
North Korea
South Korea
Kosovo
Kuwait
Kyrgyzstan
Laos
Latvia
Lebanon
Lesotho
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Macau
Macedonia
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Martinique
Mauritania
Mauritius
Mayotte
Mexico
Micronesia
Moldova
Monaco
Mongolia
Montenegro
Montserrat
Morocco
Mozambique
Myanmar
Nagorno-Karabakh
Namibia
Nauru
Nepal
Netherlands
Netherlands Antilles
New Caledonia
New Zealand
Nicaragua
Niger
Nigeria
Niue
Norfolk Island
Turkish Republic of Northern Cyprus
Northern Mariana
Norway
Oman
Pakistan
Palau
Palestine
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Pitcairn Islands
Poland
Portugal
Puerto Rico
Qatar
Republic of the Congo
Romania
Russia
Rwanda
Saint Barthelemy
Saint Helena
Saint Kitts and Nevis
Saint Lucia
Saint Martin
Saint Pierre and Miquelon
Saint Vincent and the Grenadines
Samoa
San Marino
Sao Tome and Principe
Saudi Arabia
Senegal
Serbia
Seychelles
Sierra Leone
Singapore
Slovakia
Slovenia
Solomon Islands
Somalia
Somaliland
South Africa
South Ossetia
South Sudan
Spain
Sri Lanka
Sudan
Suriname
Svalbard
eSwatini
Sweden
Switzerland
Syria
Taiwan
Tajikistan
Tanzania
Thailand
Timor-Leste
Togo
Tokelau
Tonga
Transnistria Pridnestrovie
Trinidad and Tobago
Tristan da Cunha
Tunisia
Turkey
Turkmenistan
Turks and Caicos Islands
Tuvalu
Uganda
Ukraine
United Arab Emirates
United Kingdom
United States
Uruguay
Uzbekistan
Vanuatu
Vatican City
Venezuela
Vietnam
British Virgin Islands
Isle of Man
US Virgin Islands
Wallis and Futuna
Western Sahara
Yemen
Zambia
Zimbabwe
Other
Country
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6
Main Point of Contact Name
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First Name
Last Name
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7
Contact Email
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example@example.com
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8
Contact Phone Number
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Please enter a valid phone number.
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9
Speaking Times
What time(s) slot(s) are allotted for Sergio Nazir Chavez?
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10
If you have a program copy or draft, you can upload it here.
Drag and drop files here
Select files to upload
Max. file size
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11
Speaking Topic or Theme
If you have one, this will help us prayerfully align ourselves to what you are requesting.
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12
What is the approximate length of time allotted to speak at each session or time slot?
We want to ensure we respect your time request.
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13
Will there be other speakers?
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Yes
No
Not decided
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14
If you have other speakers, please list their names.
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15
Expected attendance
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16
Who is the audience?
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17
If media is required, where should it be sent?
Media content includes personal photo, slides, etc. Please provide an appropriate email if we need to send items over to you.
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18
What is the honorarium amount you have budgeted for Sergio Nazir Chavez (excluding travel expenses)?
*
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Sergio Nazir Chavez does not make his decision based on the honorarium amount. However, our board of directors suggests a minimum of $2500 if this request is for a Sunday.
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19
If a flight is required, what is the closest airport?
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20
Will you reimburse the cost of flight for two people?
Sergio Nazir Chavez travels with someone. Our assistant will look for the best flight options in Comfort Plus.
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21
Will you reimburse hotel?
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Yes
No
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22
Will you provide or reimburse transportation?
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