Guest Speaker

Pastor/Speaker's Name:

First

Last

Pastor/Speaker Preferred Name:

Church/Ministry Name:

Church/Ministry Address:

Street Address Street Address Line 2 City State / Province / Region Postal / Zip Code Country

Phone

Contact Information

Contact Person (who we communicate with for planning purposes):

First

Last

Title:

Phone:

Cell:

Email:

Event Details and Message

Speaking Date:

Please upload headshot here:

Speaker Bio:

Message Title: *2 weeks prior to speaking date

Stage Props: *2 weeks prior to speaking date

Upload Message Notes or Images (1 of 3)

Upload Additional Message Note or Images (2 of 3)

Upload Additional Message Note or Images (3 of 3)

Would you like a confidence monitor?

Yes

No

Microphone Preference:

Travel

Arriving:

Arrival Date:

Arrival Time:

HH

:

MM

AM/PM

Airline & Flight # or FBO & Tail #

Departing:

Departure Date:

Departure Time:

HH

:

MM

AM/PM

Departure Airline & Flight # or FBO & Tail #

Number of people traveling:

Names of additional guests traveling:

Any guests under the age of 10?

Yes

No

Room Preferences

Additional Room Request:

Guest Preferences

Shoes Size

Shirt Size:

Favorite Snacks:

Favorite cold and/or hot drinks:

Meal preference (please include any special dietary needs/restrictions):

Anything additional the guest enjoys that would help us best accomodate his/her needs:

When would the guest prefer to eat?

Prior to the message

Following the message

Would you like the following services?

Make-up Artist

Hair Stylist

Other:

Finance
*Checks will be provided to guest speaker (or travel assistant when applicable) prior to departure.

Please attach W-9:

Honorarium Check Made Payable to:

Travel Reimbursement Check Made Payable to:

Media Request

Guest Speaker Information Form