Name

First Name

Last Name

Phone

(###)

###

####

Title/Position

Event, Church or Conference Name

Website

http://

Event Start Date

YYYY

Event End Date

YYYY

Event Location/Address

Can you tell me more about the event?

Anticipated Attendance, Theme, Specific Expectations

How many times at your event would you like Grace to speak?

Example: Keynote Speaker, 1 or 2 Breakout Sessions, Both or Other.

How much time will Grace have to speak?

Example: 30, 45, 60 minutes

Travel Companion

Would it be possible and in the budget for Grace to bring a travel companion?

How did you hear about Grace?

Budgeted Honorarium

FOR ALL SPEAKING INQUIRIES, PLEASE FILL OUT THE FORM BELOW.