SPEAKING
REQUEST FORM

Fill out your information below to apply to have Erwin Raphael McManus speak at your event.

Name

First Name

Last Name

Requesting Organization:

Role:

Phone

Country

(###)

###

####

Name of conference or event:

Event location:

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Event Date:

YYYY

Event type:

In-person Speaking

Virtual Livestream

Pre-recorded Message

Organization or event website:

Overall purpose of the event:

Estimated number of attendees:

Describe your audience:

(i.e. age, expertise, business people, students, pastors, etc.?)

How many sessions are you wanting Erwin to speak at?

Include number of sessions and length of each session

Dates and times of requested main speaking sessions:

Please list any other requests outside of speaking here and include times and locations if applicable.

Any outside appointments, meetings, phone calls, or media requests need to be agreed upon before confirmation of the event.

Speaker budget available:

Are you able to provide reimbursement for flights, hotel, and ground transportation (rental car or car service/pick up)?

Yes

Any additional information?