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JUNE 9-11

Speaker Request Form

Greetings! We want to make certain that we are prepared for our time together, please complete the form below. If you have any questions, please reach out to us at info@yjgministries.com.

SPEAKER INFO

Title (if applicable)

Speaker First Name

Speaker Last Name

Preferred Email

Mobile Number

Church Name

Point of Contact Full Name

Point of Contact Email

Point of Contact Title/Role

Point of Contact Mobile Number

Microphone Preference *

Earset Microphone

Hand Held Microphone

Microphone Stand

Do you have any of the following? *

Allergies

Dietary Restrictions

Food Preferences

Bevereage Preferences

Podium Preference *

Table

Podium

No Podium

Water Temp Preference *

Cold

Room Temperature

Hot

Please share dietary restrictions, food or beverage preferences, and/or allergies below.

Desired Honorarium

ACCOMODATIONS AND INCLUSIONS

Preferred Departure Airport

Please share any flight or hotel accomodation requests or preferences below. (i.e. preferred departure or arrival dates & times, airlines, seats, baggage, accesiblity, etc.)

GUEST INFO

Who will you be bringing with you as your complimentary guest? *

Spouse

Armor Bearer/Assistant

Conference Attendee Only

I am NOT Bringing a Guest

Guest Name

Guest Email

MARKETING AND COMMUNICATIONS

Will you need a product table? *

Yes

Who will manage your table?

What is your preferred name & title for us to use in our Marketing?

Please share the HIGH RESOLUTION Image (JPG or PNG) of your choice for marketing and communications purposes. (If you are having trouble please email your image to info@yjgministries.com)

Choose Image

Website

Facebook

Instagram

Twitter

Please upload a copy of your bio OR copy and paste it in the text box below.

Choose file

Copy and Paste our Your Bio Here

ADDITIONAL INFO

Please share any additional important information you would like to share with us below. (Details, Preferences, Requests, Links, Marketing Materials, etc.)

Thank you for your submission! We will be in touch if we have any additional questions or concerns. To contact us, email us at info@yjgministries.com.

An error occurred. Please check your responses above and try again. To contact us, email us at info@yjgministries.com.