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Speaker Request Form
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* Indicates required question
Which speaker(s) are you requesting?
*
Rev. Dr. Terrance J. Gattis, Senior Pastor
Rev. Dr. Elaine Gattis, Associate Pastor
Rev. Larraine Forrester, Minister of Marriage/Family Life
Min. Cynthia Bryant, Associate Minister
Youth Pastor
Other:
Required
Date & Time Event Begins
*
MM
/
DD
/
YYYY
Time
:
AM
PM
What time should speaker arrive?
*
Time
:
AM
PM
What is the expected duration of the event?
*
Hrs
:
Min
:
Sec
How much time is allotted to speaker?
*
Hrs
:
Min
:
Sec
Contact Information
First Name
*
Your answer
Last Name
*
Your answer
Phone Number
*
Your answer
Email
*
Your answer
Event Information
Name of Church/Organization
*
Your answer
Website
Your answer
Name of Senior Pastor/Founder/Leader
*
Your answer
Name of Event Location
*
Your answer
Address
*
Your answer
City
*
Your answer
State
*
Your answer
Zip
*
Your answer
Email
*
Your answer
Event Attire
*
Church Attire (Suit/Dress Suit)
Church Casual (Slacks, Polo/Blouse/No tie/jacket)
Casual (Jeans/Khakis/Come as you are)
Other:
Special Event colors (optional)
Your answer
Are there any special guests / honorees? If so, please provide full name and title:
Your answer
Does your event have a special theme or scripture? If so, please indicate in the space provided:
Your answer
Additional Information
Please provide any additional information in the space below:
Your answer
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