SPEAKER ENGAGEMENT REQUEST FORM

SPEAKER ENGAGEMENT REQUEST FORM

FOR BISHOP LARRY D. TROTTER
CHURCH/ORGANIZATION INFORMATION
Pastor/Host Name

First Name Last Name
Spouse Name

First Name Last Name
Church/Organization Name
Address

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code Country
Phone Number

Area Code Phone Number
Fax Number

Area Code Phone Number
Office Hours
Web Address
EVENT INFORMATION
Event Name
Event Theme
Event Address

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code Country
Type of Event
Date(s) Ministry is Requested
Anticipated # of Attendants
Event Start Time

Month Day Year Hour Minutes AM/PM Option
Event End Time

Month Day Year Hour Minutes AM/PM Option
Airport Nearest Your Location
Special Topic Requested

Yes No
If yes, please list
Please list names of other participating speakers and their ministry dates and times.
Contact Information
Contact Person

First Name Last Name
Contact Phone Number

Area Code Phone Number
Alternate Number

Area Code Phone Number
Fax Number

Area Code Phone Number
E-mail
Do you allow the sale of media products?

Yes No
Will someone be available to assist in the sale of our products?

Yes No
Should be Empty:

CHURCH/ORGANIZATION INFORMATION