Speaker Request Form Host Name*Church, Ministry, or Organization NameAbout You*We'd love to hear more about your church or organization. Who are your leaders, and who is your audience? What is your mission and goal? Thanks for helping us to get to know you.Have you ever hosted an event?*Please tell us when and what kinds of events you've hosted, including typical attendance.Will you be partnering with other churches/ministries for this event?*NoYesThird ChoiceCoordinator Name* First Last Coordinator Email* Coordinator Phone*Venue Address* Street Address Address Line 2 City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code What is the nearest airport and how far away is it from the venue?*Which speaker would you like to request (first choice)?*Ed WelchMike EmletJulie LoweMonica KimCecelia BernhardtTodd StyrdDarby StricklandJayne ClarkAaron SironiNo PreferenceWhich speaker would you like to request (second choice)?*Ed WelchMike EmletJulie LoweMonica KimCecelia BernhardtTodd StyrdDarby StricklandJayne ClarkAaron SironiNo PreferenceRequested Topic*Please list suggested title and description of eventObjectives*What are the goals for your event? Who is your target audience? How many attendees do you anticipate?Event Length*Please list number of days/hours for eventEvent Start Date* Date Format: MM slash DD slash YYYY Event End Date* Date Format: MM slash DD slash YYYY Proposed Schedule*Please list number of sessions and expectations of speaker, including any staff meals, Q&A, etc.How did you hear about CCEF?*Are you a CCEF donor/supporting church?*Is there anything else CCEF needs to know or do you have any questions?*PhoneThis field is for validation purposes and should be left unchanged.
