* Name

* Email

Date(s) of Event

Type of Conference

Is he the main speaker?

Other speakers (e.g. Speaker1, Speaker2, etc.)

How many plenary sessions are you requesting Jay to speak for?

How many workshops or breakout sessions are you requesting him to speak for?

Schedule and Duration of speaking times (e.g. Plenary Session at 9am on 1/2/08, 1 hour in length)

Are there any particular topics you would like him to speak about in each session?

Estimated number of attendees

Makeup of the attendees (e.g. age range, urban, pastors, lay leaders, church planters, ethnic diversity, etc.)

Organization’s name and mailing address

Contact person, phone/fax/email info

How do you know Jay? (e.g. Where and when did you meet him? Who referred him to you?)

Overall purpose of the conference

Location and address of event site

Location of nearest airport to event

Is a photograph and biography of Jay required?

What typical honorarium do you provide for this event?

Are you able to provide accommodations and expenses for travelling?

Other Notes

* Verify