SPEAKER REQUEST FORM

This form allows you to request a speaker. Upon receipt, your information will be recorded, reviewed, and a Public Relations staff member will contact you regarding the status of your request. In the interim, if you have an inquiry, please e-mail: publicrelations@tdjakes.org

Speaker Information:

Name of Requested Speaker Why are you requesting this person? Are you willing to accept another speaker from this organization?

Presentation Information:

What is the Topic? What is the Format of this presentation? What equipment will be provided?

Event Information:

Date of Presentation Begin Time End Time Location Event Name Purpose of Event Theme Will there be pre- or post-activities?: If yes, explain?: