SPEAKING REQUEST FOR PASTOR JESSIE L. SIMMS
Thank you for considering Pastor Jessie L. Simms to speak at your event! Let's start the conversation.
Contact name
*
First Name
Last Name
Contact Email
*
example@example.com
Contact Phone Number
*
Format: (000) 000-0000.
Ministry/Organization Name
*
Pastor/Host Name
*
Ministry/Organization Website
Ministry/Organization Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
EVENT INFORMATION
Please share with us details about your ministry/organization event.
Event Name
*
Type of Event (Select One)
*
Please Select
Church Anniversary
Church Dedication
Conference/Convention
Media Request(i.e. Interview, Radio/TV Appearance, etc.)
Pastoral Anniversary
School Event
Special Program(i.e. Graduation, etc.)
Worship Service
Youth Conference
Youth Sunday
Other
Date of the Event
*
-
Month
-
Day
Year
Date
Hour Minutes
AM
PM
AM/PM Option
Event Date. Please indicate whether request is for one day or multiple (series) dates:
*
Request for one date
Request for multiple dates
Event Address (if different from above)
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Closest major airport to the event city
*
What is the approximate distance, in miles, from closest major airport to event location (required for events outside of Georgia)?
Has Pastor J. previously been a Guest Speaker/Facilitator at one of your events?
*
Yes
No
Anticipated attendance for event
Please Select
0-50
51-150
151-300
301-500
501-1000
1001-1500
1501+
Will this engagement be broadcast live via the Internet or television?
*
Yes
No
Do you allow the sale of media products?
*
Yes
No
Honorarium offer from your ministry/organization to J. L. Simms Ministries.
*
Additional event details (e.g., theme, multiple dates, event type, etc.)
0/1500
Names of other participating speakers and their ministry dates and times:
0/1500
Thank you for filling out this speaking engagement questionairre. We will review your information and get in contact with you soon!
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