Speaking Engagement Request Form
Date
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Organization Name
Event Date
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Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Event Location
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Event Theme/Topic
Speaker Request
Preferred Speaker(s)
Please Select
Marcie Consiglio, Executive Director
Lori Manteghi, Houseparent
Sati Manteghi, Houseparent
Marcie and Lori
Sati and Lori
Marcie, Sati, and Lori
Reason for Speaker Choice
Contact Information
Name of Requester
First Name
Last Name
Organization/Company
Email
example@example.com
Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
Event Audience
Estimated Audience Size
Please Select
Under 25
25–50
50–100
100+
Audience Demographics
Business / civic group
Church congregation
Community organization
Small group / Bible study
School / college group
Youth / young adult group
Other
Age Range of Audience
Please Select
Teens (13–17)
Young Adults (18–25)
Adults (26–55)
Seniors (55+)
Mixed / Family
Speaking Engagement Types
Community/Nonprofit
Please Select
Church Services / Ministry Nights – sermons, testimonies, or special teaching
Community Events – local fundraisers, charity events, awareness campaigns
Workshops & Training Sessions – practical skill-building or life-skills classes
Panel Discussions – multiple voices on a shared topic (faith, social issues, leadership)
Educational/Youth
Please Select
School Assemblies – motivational or awareness-based talks
College/University Guest Lectures – focused on your area of expertise or life experience
Youth Groups & Camps – inspirational and mentoring-focused speaking
After-School Programs – life skills, motivation, or personal development
Business/Professional
Please Select
Corporate Training – leadership, teamwork, communication, or diversity sessions
Keynote Addresses – at conferences or professional gatherings
Lunch & Learn Sessions – shorter, practical talks in workplace settings
Workshops & Seminars – skill-specific teaching (time management, conflict resolution)
Faith-Based
Please Select
Women’s or Men’s Conferences – inspirational and practical talks
Retreats – deeper teaching or multi-session speaking
Bible Studies or Small Groups – teaching or discussion facilitation
Mission Events – sharing vision, impact stories, or fundraising efforts
Media/Online
Please Select
Podcasts & Interviews – guest speaker or subject matter expert
Webinars – educational, inspirational, or training topics delivered online
Virtual Conferences – keynote or breakout sessions
Social Media Live Streams – direct audience engagement in real time
Duration of Session
Hour Minutes
Available AV/Equipment for presentation
TV
Apple TV
Flash Drive Capable
Other
Other Requests or Comments
Submit
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