Contact 3 — Clayton Baird

SPEAKING REQUEST FORM

Thank you for your interest in requesting Clayton to share at your church/event. We kindly ask that you complete the speaking request form below. We look forward to responding back to you quickly.

Church / Organization Name

Leader / Pastor Name

First Name

Last Name

Church / Organization Website

http://

Church / Event Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Contact Name

First Name

Last Name

Contact Title

Contact Email

Contact Phone

(###)

###

####

Event Name

Type of Event (ie. conference, seminar, weekly service)

Event Date(s)

Event Venue & Address

Expected Attendance

Audience Type (ie. adults, students, leaders, pastors)

How many times will Clayton speak?

Preferred speaking time / length of message

If you have invited other speakers to your event, please list those confirmed.

This event is prepared to provide an honorarium.

YES

If YES, please list the designated honorarium:

Nearest Airport

Only needed if Clayton will be required to fly from Jacksonville, FL

Will airport transportation be provided?

YES

If YES, please provide the driver's name:

Approval to pay for travel companion?

YES

Hotel Name? Address?

Only needed if Clayton will be required to stay in town overnight.

Additional Comments