Speaker Interest Form
Thank you for your interest in having Christina as a speaker. Please fill out the form below to indicate your interest and she will let you know about her availability. 
* Indicates required question
Email *
First & Last Name
Your answer
Phone Number
Your answer
Name of the Event
Your answer
Sponsoring Church or Organization (Name and website)
Your answer
Location of the event
Your answer
If in-person, location of nearest airport?
Your answer
Desired Dates? Please include times (i.e. All Day, afternoon, etc)
Your answer
Event Description
Your answer
Have you chosen a theme or specific topics for the event? If yes, please explain.:
Your answer
How many sessions are you requesting Christina to speak at?:
Your answer
Proposed length of sessions?
Your answer
Estimated number of attendees?
Your answer
What is your budget for Christina's travel fees if travel is necessary? (flight, ground transportation, hotel)? 
Your answer
What is your budget for Christina's speaking fee?:
Your answer
How did you hear about Christina?
Your answer
Thank you for taking time to fill out this interest form. Christina will be in touch as soon as she is able!
For more information about ReFocus, go to www.refocusministry.org
Submit
Clear form
Never submit passwords through Google Forms.
This form was created inside of Refocus Ministry Inc.

Does this form look suspicious? Report

Google Forms
 
 
Sign in to continue
Cancel
sign in
To fill out this form, you must be signed in.
Report Abuse
Cancel
sign in