Speaker Request Form

Name *

First Name

Last Name

Phone *

(###)

###

####

Date of the event *

If spanning multiple days please indicate in the notes section

MM

DD

YYYY

Attendees will consist of... *

Ministry Leaders

Pastors

Deacons

Lay-Leaders

Members

Would you allow PS to exhibit and sell resources at your event? *

YES

NO

Are you willing to cover Brian's honorarium? *

Honorarium for weekend event and preaching is set at $1000 by the PS board. If you are unable to do this please answer no and explain in the notes. Inability to supply full honorarium does not mean that Brian will reject speaking at your event.

YES

NO

MAYBE

Are you willing to cover Brian's travel? *

YES

NO