Speaking Request Form
Thank you for your interest in having Michael J. Kimpan speak with your team, university, faith community, organization or group. Please kindly complete the following form to give us an idea of how we can partner together.

You will be directed to a confirmation page upon successful submission of this form.

PLEASE NOTE :: Submission of this form does not constitute a contract or agreement; we will contact you with further details within 72 hours upon receiving your request.

Summary of potential speaking engagement: *
Please include any details about the audience, desired topic you’d like Michael to address, location and type of venue and event, as well as any applicable links for further information.
Your answer
Potential date(s) for speaking engagement: *
If dates are flexible, please note that below.
Your answer
Your name (contact person for the event): *
Your answer
Your email address: *
Your answer
Additional information you think may be useful, or questions you may have:
Your answer
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