Speaker Request Form
Please select the member(s) of our Pastoral team you are requesting:
Pastor Kimberly Bulgin
Pastor MyRon Edmonds
Pastor Regina Johnson
Event Contact Info
Main Point of Contact.
Last Name
First Name
Title/ Position
Phone Number
Email Address
What is the best way to reach you?
Email
Phone
Name of Organization/ Church
Organization/ Church Website
Street Address
City
State/ Region/ Province
Zip Code/ Postal Code
Country
Event Info
Is this event sponsored by your church/ conference?
Yes
No
Do you have Pastoral and Board support for your request?
Yes
No
Name of Local Pastor
Last Name
First Name
Phone
Email Address
Type of Event
Worship Service
Revival
Training
Evangelistic
Youth Rally
Conference
Other
Target Audience (Please select all that apply.)
Youth (13-18)
Young Adults (18-35)
Adults (35-65)
Seniors (65+)
Students
Professionals
Adventists
Christians
Non-Christians
Event Start Date
Event End Date
Are your dates flexible?
Yes
No
What is the anticipated attendance?
How many presentations/ sermons?
Please list any other speakers that will be at this event.
Church's Spiritual Health (If applicable)
Choose one:
On Fire!
Active
Waking Up
Sleepy
Dead
Specific Topic(s) of event
Event Goals (Please be specific)
Anything else you want to tell us?
SUBMIT
Thank you for your request. We will review and respond as soon as possible.