Booking Request Form
I look forward to serving you
Cost for Miriam to speak
$300 per workshop / speaking request
NAME of Organiser
*
First Name
Last Name
NAME of Organisation
*
CONTACT Number
*
Please enter a valid phone number.
Format: 0000-000-000.
CONTACT Email
*
example@example.com
ADDRESS
Street Address
Parking information
City
State / Province
Postal Code
NAME of Event
Does not need to be final
DATE of Event and TIME of Talk
*
DESCRIPTION of Event
SPEAKING REQUEST
Including Length of Talk and Desired Outcome
DESCRIPTION of Venue
The room the talk will be delivered in
RESOURCES Available
Data Projector
TV Screen
Whiteboard
Other
SEATING Arrangement
Anticipated AUDIENCE
Number, Characteristic
HANDOUTS Required
BOOKSTALL
If stocked, or I should bring books
BIBLE VERSION Preferred
OTHER Helpful Info
Print
Submit
Should be Empty: