Speaker Request
All fields marked with a * are required:
Pastor/Head of Ministry
*
Spouse Name:
Church/Organization:
*
Church/Organization Address:
*
City:
*
State:
*
Zip Code:
*
Church/Organization Phone:
*
Fax:
Service Location:
Contact Person:
*
Event Coordinator Mobile Phone:
Email Address:
Church Website:
Length of Ministry Existence:
Facility Seating Capacity:
Expected Attendance:
Event Name:
Event Theme:
Event Day, Date & Time:
*
Event Location:
*
Event Scripture(s):
Event Colors:
Event Registration Fee:
Event Attire:
Comments:
Person Meeting Dr.Malone:
Contact Number:
Will service be video taped?
Yes
No
Will a cordeless microphone be available?
Yes
No
Will a lapel microphone be available?
Yes
No
May Dr.Malone offer products?
Yes
No
If yes, will a six foot table be avaliable?
Yes
No
What time is setup?
Please give name of contact person:
Is book signing possible?
Yes
No
Signature:
*
Date:
*
