Kingdom Girl Reclaimed Speaker Request Form
Bring hope, healing, and Kingdom restoration to young women in your community.
Section 1: Organization Details
Organization / Church / Facility Name:
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Type of Organization:
*
Church
Youth Center
Detention Center
School / Educational Institution
Shelter / Group Home
Other
Contact Person Name:
*
First Name
Last Name
Email
*
example@example.com
Phone Number
*
Please enter a valid phone number.
Organization Website (if applicable):
Section 2: Event Information
Event Name (if applicable):
*
Requested Date(s):
*
Start & End Time
*
Location/Address of Event:
*
Expected Audience Size:
*
Age Range of Participants:
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12–14
15–17
18–21
21–25
Mixed Ages
Section 3: Speaking Topics (Choose all that apply)
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Reclaiming Identity in Christ
Healing After Mistakes
Boundaries, Friendships & Relationships
Purity & Purpose
Emotional Healing & Forgiveness
Spiritual Warfare & Deliverance
Custom Topic Request:
Section 4: Format & Setup
Preferred Speaking Format:
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Keynote / Main Speaker
Workshop / Interactive Session
Panel Discussion
Other
Event Style:
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In-Person
Virtual
Hybrid
Will audio/visual equipment be provided?
*
Yes
No
Not Sure
Additional Notes or Special Requests:
*
Section 5: Prayer & Alignment
We believe in divine alignment. Please let us know how we can pray for your youth, ministry, or event.
Final Step
☐ I understand this is a speaker request form only and does not guarantee booking until confirmation is received.
Signature
*
Date
*
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Month
-
Day
Year
Date
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