Speaker Request Form

Host Name*

Church, Ministry, or Organization Name

About You*

We'd love to hear more about your church or organization. Who are your leaders, and who is your audience? What is your mission and goal? Thanks for helping us to get to know you.

Have you ever hosted an event?*

Please tell us when and what kinds of events you've hosted, including typical attendance.

Will you be partnering with other churches/ministries for this event?*

Coordinator Name*

First Last

Coordinator Email*

Coordinator Phone*

Venue Address*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

What is the nearest airport and how far away is it from the venue?*

Which speaker would you like to request (first choice)?*

Which speaker would you like to request (second choice)?*

Requested Topic*

Please list suggested title and description of event

Objectives*

What are the goals for your event? Who is your target audience? How many attendees do you anticipate?

Event Length*

Please list number of days/hours for event

Event Start Date*

Event End Date*

Proposed Schedule*

Please list number of sessions and expectations of speaker, including any staff meals, Q&A, etc.

How did you hear about CCEF?*

Are you a CCEF donor/supporting church?*

Is there anything else CCEF needs to know or do you have any questions?*

Name

This field is for validation purposes and should be left unchanged.