Speaking Engagement Request Form

Thank you for your interest in having James Emery White participate in your event. We prayerfully evaluate each request in regard to strategic Kingdom impact in addition to his schedule and availability.

To make your request, please fill out the following information and someone from Church & Culture will be in touch with you soon.

Name

First Name

Last Name

Email Address

Organization

Phone

(###)

###

####

Date(s) of the Event

Please provide the date(s) the event will be taking place.

Time of the Event

Website

If you have a website established for this event, please share that here.

http://

Name of the Event

Location of the Event

Please provide facility name and address.

Other Speakers?

Will there be others speaking at this event? If so, please let us know who.

Target Audience

Anticipated Attendance

Number of Talks

Topic for the Talk(s)

Length of the Talk(s)

Breakout Sessions (if applicable)

If you need Dr. White to participate in breakout sessions, please provide the number and length.

Anticipated Honorarium