Speaking Engagement Request Form

Contact Person*

First Last

Email*

Phone*

Name of the church/organization hosting the Event*

Church Address*

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

Event Name*

Location of Event*

Event Venue Address

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

*Only complete if different from church address

Event Start Date*

Event End Date*

Same as event start date if a one day event

Date of PM Speaker's Bureau presentation*

Time of PM Speaker's Bureau presentation*

:

Event Webpage

Event Type*

Event Description*

Number of attendees expected*

Age and Background of attendees*

List any other speakers/groups who are part of the event*

If this is a panel discussion, list the other panelists

Speaking Topics*

Choose one or more topics that you would like to hear about at your church's men's event by a member of the PointMan Speakers Bureau.

Choose a Speaker*

Would you accept an alternate speaker?*

Would you like the speaker's wife to be present?*

Will the hosting church/organization reimburse the speaker's travel expenses?*

Will there be audio/video projection available?*

Additional Notes

Lead International