Speaking Request Form

SPEAKING REQUEST FORM

Thank you so much for inviting Pastor John J. Wagner to your upcoming event! He is humbled and honored by every opportunity. Please take time to fill out this form below and someone from our office will contact you as soon as possible.
Name of the Church/Company: *
Name of Pastor/Contact Person: *

First Name Last Name
Pastor/Contact Person's Email: *
example@example.com
Assistant's Name:

First Name Last Name
Assistant's Email:
example@example.com
Contact Phone Number:

Area Code Phone Number
Speaking Information
Date of Event:

Month Day Year
Date
Name of the Event: *
Purpose of Event: *
Schedule and Duration of Speaking Times: *
Past Speakers at this event:
Present Speakers at this event:
Makeup of Attendees (Pastors, Lay Leaders, Church Planters, etc): *
Projected Number of Attendees: *
What topic would you like Pastor John to speak on? *
Travel Information
Location of Event Site: *
Address of Event Site: *

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code Country
Nearest Airport:
Distance to Airpot from Speaking Location:
Pastor John never travels alone. Would you be willing to cover flight costs for another person? *

Yes No
Budgeted honorarium: (Please note Pastor John does not have a specific fee) *
Should be Empty:

SPEAKING REQUEST FORM