General Information

Name of Church/Organization

Church/Organization Website

Organization's Contact Person

Name of Contact Person

Mailing Address

Phone Number


Assistant's Name (if applicable)

Assistant's Contact Information (if applicable)

Speaking Information

Event Date

Event Name

Event Location & Address

Event Purpose & Target Audience

Event Schedule & Duration of Speaking

Speaking Topic(s)

Will there be other speakers?

If applicable, who are the other speakers?

Estimated Number of Attendees

Allotted Budget for this Event

Travel Information

Nearest Airport

Distance to Speaking Venue from Airport

Colleen typically travels with a staff or family member. Would travel costs for one additional person fit into your event budget?