Speaking Request

Thank you for your interest in having Joe Thorn and/or Jimmy Fowler participate in your event. Please fill out the form below, and you will be contacted once the request has been reviewed.

Event Planner/Conctact Person

First Name

Last Name

Email Address

Phone

(###)

###

####

Desired Speaker(s)

Event Name

Event Website

http://

Event Sponsor (Organization or Church)

What is the vision for and purpose of this event?

Event Start Date

YYYY

Event Close Date

YYYY

Are there specific topics you want to be addressed?

Who is the target audience?

How many do you expect in attendance?

What other speakers will be involved?

Where will the event take place?

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Will you cover all travel expenses?

Yes

If not, please explain the reason below.

Honorarium

Is there anything else you would like us to know about this event?