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Speaker Request Form
Whether it’s an audience of 10 to 2500, I’ve had the privilege of speaking at camps, events, and training in multiple settings and demographics. Want me to speak at your event? Fill out the speaker request form below and we’ll talk!
* Indicates required question
Event Name
*
Your answer
Event Date
*
MM
/
DD
/
YYYY
Event Objective:
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Your answer
Is this a virtual event?
*
Yes
No
Required
Who will be attending?
(Check all that apply)
Students
Youth Leaders
Parents
Ministry Leaders
Unchurched
Churched
(Check all that apply)
Students
Youth Leaders
Parents
Ministry Leaders
Unchurched
Churched
Total Expected Attendance:
*
Your answer
Total Expected Youth Leaders:
Your answer
Total Expected Students:
Your answer
Contact Name
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Your answer
Contact Email
*
Your answer
Phone Number:
*
Your answer
Website of event, church, or ministry:
*
Your answer
Questions/Notes:
Your answer
How did you hear about Keith Seymour or YouthMinWins?
*
Your answer
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