Speaker Request Form

Your name: *

Your email: *

Speaker you're requesting: *

Event Date: *

Type of conference: *

Number of workshops: *

Schedule & duration of speaking times: * (e.g. Plenary Session, Workshops, etc.)

Is he/she the main speaker? * Yes
No

Other speakers: * (e.g. Speaker 1, Speaker 2, etc.)

Estimated number of attendees: *

Makeup of the attendees: * (e.g. age range, urban pastors, lay leaders, church planters, ethnic diversity, etc.)

Organization's name & mailing address: *

Contact person for this event: *

Phone number and email for the contact person: *

How do you know this speaker? * (e.g. Where and when did you meet him/her? Who referred him/her to you?)

Overall purpose of the conference: *

Requested topic: *

Location and address of event site: *

Name and location of nearest airport to the event site: *

Will you be needing a photograph and biography? * Yes
No

As part of Granger Community Church's commitment to leadership development and to support our speakers, we believe in allowing other lay leaders, staff members or family members to accompany our leaders for speaking engagements.

Would you be willing to provide travel expenses to accommodate this priority? * Yes
No

What typical honorarium do you provide for this event? *

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