Request a Speaker

To request a speaker, please fill out the form below.

Church or Organization: *

Denomination: *

Senior Pastor or Leader: *

Phone: *

Fax:

Email: *

Event Coordinator: *

Offsite Phone: *

Street Address: *

City: *

State: *

ZIP: *

Event Date(s) Requested

First Choice: *

Second Choice: *

Third Choice:

Fourth Choice:

Speaker (first choice): *

Please enter your first choice for a speaker.

Who is your target audience?: *

Church Leaders Only

Laity and Leaders

Other

Target Description: *

Describe the audience (age group, demographics, etc.) and the topic(s) you would like to be covered.

Church / Organization Size: *

Total Attendees Anticipated: *

Previous Seminars

Has your church ever hosted a seminar?: *

Yes

If so, when was the last one?: *

If so, how many typically attend your seminars?: *

What seminars have you hosted in the past three years?: *

What attracts people to your church?: *

How did you hear about CCEF?: *

Name of nearest airport: *

How far is the airport from the seminar site?: *

What code is in the image?: *

Copy the characters (respecting upper/lower case) from the image.

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