Your Full Name

Associated Organization/Church

Phone

Email Address

Who would like to speak at your event? Who would like to speak at your event? Linson Daniel Jon Hietbrink Eric Rafferty

When is your event?

Where will your event be held?

What is the theme or scripture focus?

Please provide a short description of your event (i.e. goals for the event, target audience, number of talks, etc.)

Will you or your group consider an honorarium, if any, for speaking? Will you or your group consider an honorarium, if any, for speaking? Yes No