Speaker & Event Request Form

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Please answer the following questions if you are interested in requesting a Fieldstone Counselor to speak at your church or organization (excluding Jonathan Holmes). Once we have reviewed your completed form, we will reach out to confirm your event details. For additional questions or concerns, you may contact our Content Department via email: events@fieldstonecounseling.org

If you are interested in having our Executive Director, Jonathan Holmes, speak at your event, please exit this form and visit https://fieldstonecounseling.org/team/jonathan-holmes to fill out his specific request form.

Email *

Your Name *

Email *

Church/Organization (Event Host) *

Please note if the location of the event will be different than the host name.

Are you currently a partnering church with Fieldstone? *

Partnering churches receive tiered benefits, and as such, may qualify for a complimentary or reduced seminar.

Yes

No, but I would like more information about it.

Required

1st Choice of date for your event *

Please keep in mind that we have been experiencing an increasing volume of interest, which means most speaker/event requests need a minimum of 8-12 weeks notice.

YYYY

2nd Choice of date for your event *

YYYY

Time of event *

Time

Host/Church/Organization website *

Who is the audience? *

Please include estimated # of attendees and intended audience. Will this be an event specific to men, women, married couples, parents, etc.?

Event Coordinator (or point person from your church/organization) *

Event Coordinator Email & Phone Number *

Travel Requirements *

Please provide general information on whether this will require the speaker to fly (nearest airport) or if an overnight stay is needed (nearest hotels). Our counselors are all located in NE Ohio

Requested Topic(s) *

If you would like to view our "Equipping With Fieldstone" document for full descriptions of current offerings, please note that below in your response and we will email it to you. If you would like us to speak on a different topic than those offered, please keep in mind that we may/may not be able to accommodate your request depending on the preparation time needed and the experience and specializations represented within our team of counselors.

Will you be recording the event (audio and/or visual)? *

Please note that we request any video recordings only be made available within your church/organization and not shared on public platforms. This is to guard the integrity and publishing rights of our counselors as the creators of the content.

Yes

Unsure

Please provide a rough schedule for the event. (This can be edited as needed) *

Please review the "Terms for Requesting a Speaker from Fieldstone Counseling" document below for speaker pricing and other logistical details. Then answer to indicate that you have read and agree to the terms. *Please note that the prices listed below are estimates. We will provide an accurate price for your request once our team has reviewed your request. Prices vary based on a number of factors including: topics, timelines, speaker requested etc. *

Yes and Agree

Required

Additional questions and comments

Send me a copy of my responses.

Submit

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