Request a Speaker Contact Name * Organization Name * Phone Number * Email * Preferred Method of Contact * Call Text Email Anticipated Audience Size * Proposed Date * Year20182019202020212022 Year MonthJanFebMarAprMayJunJulAugSepOctNovDec Month Day12345678910111213141516171819202122232425262728293031 Day Proposed Time * Hour123456789101112 Hour :Minute000510152025303540455055 Minute am pm Is this date flexible? * Yes No Length of Time Allotted for the Speaker * Location * Specific Area of Interest * World Relief Overview Anti-Human Trafficking Immigration Refugees Church Empowerment Other What is the overall purpose of the event? * What outcomes do you hope to achieve? * Is your organization hoping to get involved with World Relief? * Yes No Describe the Makeup of the Audience * What audio/video accommodations will be available? * Have you hosted a World Relief speaker/training in the past? If yes, who and when. * Is your organization able to provide an honorarium? * Yes No If yes, please specify. Other comments Leave this field blank Submit
