Lesa Willis Ministries Speaking Engagement Request Form

Speaking Engagement Request Form
Event Name
Event Date

MonthDayYear
Date
Event Location

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Event Theme/Topic
Speaker Request
Speaker Topic(s)

Topic 1Topic 2
Reason for Speaker Choice
Budget for Speaker $
*(travel, room and board not included)
Contact Information
Name of Requester

First NameLast Name
Organization/Company
Email
example@example.com
Phone Number
Please enter a valid phone number.
Event Audience
Expected Audience Size
Audience Demographics

ChurchStudentsGeneral publicIndustry professionalsOther
Logistics
Speaker Session Format

KeynotePanel discussionWorkshopMistress of CeremonyOther
Duration of Session

Hour Minutes
Equipment/AV Available
Other Requests or Comments
Will the event be live streamed or recorded? (If so, a copy will be requested)

YesNo
Internet access available?

YesNo
Vendor table available for book/product sales?

YesNo
Interested in purchasing books for registrants?

YesNoMaybe
Additional Information
*Travel Guidelines:
*Preferred Airline: Southwest Airline
**All flights must include a minimum of two checked bags, one carry-on and one personal bag.
Hotel Guidelines:
Double bed, desk

*Discussions regarding alternative accommodations can be held with the ministry administrator.
Should be Empty:

Speaking Engagement Request Form