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

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

Area CodePhone Number
Speaking Information
Date of Event:

MonthDayYear
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

CityState / Province

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

YesNoOther
Budgeted honorarium: (Please note Pastor John does not have a specific fee)*
Should be Empty:

SPEAKING REQUEST FORM