Request Form for Lay Speakers

REQUEST FORM FOR LAY SPEAKERS
Please use this form for incoming Speakers for any substitutes, parish missions, retreats, workshops, etc. Any time a Speaker NOT affiliated with the Fort Worth Diocese gives a presentation on Church property or on behalf of the Church, it is appropriate to use this form.
PARISH OR DIOCESAN INSTITUTION REQUESTING THE SPEAKER
Parish/Institution Name
Parish/Institution contact person
Phone Number
Format: (000) 000-0000.
Email
Event Start Date

MonthDayYear
2 digit month, 2 digit day, 4 digit year
Event End Date

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Event Description (retreat, conference, etc.)
SPEAKER INFORMATION
This Person will be
This Person will be working with children?
Name of incoming Speaker
Address
(Please enter Street Address, City, State, Zip Code)
Phone
Format: (000) 000-0000.
Email
Website
From what Diocese/Religious Institution/ Employment
Contact Person
Address
(Please enter Street Address, City, State, Zip Code)
Phone Number
Format: (000) 000-0000.
Email
DIOCESAN USE ONLY
Date received

Notified by (date)

Approved By

Director of Catechesis - Yes No

Name

Approved By

Chancery Department - Yes No

Name & Title
Should be Empty:

REQUEST FORM FOR LAY SPEAKERS