SPEAKING REQUEST — LIFE RESTORATION

Speaker Request Form

Life Restoration Ministries is honored to receive your speaker request. The number of invitations we receive are many and as such we discern wisely which opportunities to participate in. Providing as much information as possible will assist us in our discernment process. Thank you for your interest.

Organization Name

Contact Name

First Name

Last Name

Contact Email

Contact Phone

Country

(###)

###

####

Which speaker(s) are you requesting?

For both Heather and Jake, select both boxes.

Heather Khym

Jake Khym

Do you require a letter of good standing issued by the home diocese of the speaker(s)?

Event Date

YYYY

Please provide a brief description of the event (theme, target audience, type of event).

What is the expected number of attendees for this event?

Where will the event be located?

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

If other speakers will be participating at the event, please list their names below.

What day/time is/are the speaker(s) expected to arrive?

What day/time can the speaker(s) be expected to depart?

How many talks do you want the speaker(s) to give?

What is the expected length of each talk?

Will there be an AV technician present at the event?

Will the speaker(s) have access to a projector, screen, and computer audio?

What is your budgeted speaker(s) fee for this event?

Life Restoration charges a standard speaker fee that will be discussed with your organization.

Is your organization prepared to pay travel and accommodation costs?

Is there anything else LRM should know about your event?

We have a vision to see every person encountered by Jesus and live out their God-given genius.

EVENTS

COURSES

Speaker Request Form

We have a vision to see every person encountered by Jesus and live out their God-given genius.

LIFE RESTORATION MINISTRIES