Speaking Request Form

SPEAKING REQUEST FORM

Thank you so much for inviting Reverend Brian Alarid to your upcoming event! He is humbled and
honored by every opportunity. Please take time to fill out the form below and someone from our
office will contact you as soon as possible!

EVENT ORGANIZER EVENT ORGANIZER

Name of Requesting Church/Organization

Type of Organization Type of Organization Non-Profit For Profit Other

POINT OF CONTACT POINT OF CONTACT

Name

Title

Phone

Email

Assistant's Name

Assistant's Phone

Assistant's Email

EVENT DETAILS EVENT DETAILS

Event Name

Event Website

Event Date(s)

Event Time(s)

Purpose of Event

Event Type (Dinner, Conference, etc.)

Event Format (Keynote, Roundtable, Panel, etc.)

Requested topic (please be as specific/descriptive as possible)

Past Speakers at this Event

Present Speakers at this Event

Besides the talk, are there other events/agenda items that he'll be required to attend? If yes, please provide details.

AUDIENCE AUDIENCE

Expected Attendance

Description of Attendees (Pastors, Lay Leaders, Church Planters, etc)

Cost of Attendance

Will media be present? Will media be present? Yes No

Which media outlets?

ADDITIONAL DETAILS ADDITIONAL DETAILS

Event Attire

Nearest Airport to Event Venue

Distance to Airport from Speaking Location

Will reimbursement for travel cost be available? Will reimbursement for travel cost be available? Yes No

Reverend Alarid never travels alone. Would you be willing to cover travel costs for another person? Reverend Alarid never travels alone. Would you be willing to cover travel costs for another person? Yes No

Budgeted honorarium

6 + 14 =