Speaker Request Form

Life Restoration Ministries USA is honored to receive your speaker request. The number of invitations we receive are many and as such we discern wisely which opportunities to participate in. Providing as much information as possible will assist us in our discernment process. Thank you for your interest.

Organization Name

Contact Name

First Name

Last Name

Contact Email

Contact Phone

Country

(###)

###

####

Which Speakers are you requesting?

For Heather and Jake, select both boxes.

Heather

Jake

Do you require a letter of good standing from the speaker's home diocese?

Select yes or no.

Event Date

Please enter the start date for the event.

YYYY

Please provide a brief description of the event (theme, target audience, type of event, etc.)

What is the expected number of attendees for the event?

Where will the event be located?

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

If other speakers will be participating in the event, please list their names below.

What day/time is/are the speaker(s) expected to arrive?

What day/time can the speaker(s) be expected to depart?

How many talks do you want the speaker(s) to give?

What is the expected length of each talk?

Will there be an AV technician present at the event?

Will the speaker(s) have access to a project, screen and computer audio?

What is your budgeted speaker(s) fee for this event?

Life Restoration Ministries charges a standard speaking fee that will be discussed with your organization.

Is your organization prepared to pay travel and accommodation costs?

Is there anything else LRM USA should know about your event?