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!
Event Name *
Event Date *
MM
/
DD
/
YYYY
Event Objective: *
Is this a virtual event? *
Required
Who will be attending?
(Check all that apply)
Students
Youth Leaders
Parents
Ministry Leaders
Unchurched
Churched
Total Expected Attendance: *
Total Expected Youth Leaders:
Total Expected Students:
Contact Name *
Contact Email *
Phone Number: *
Website of event, church, or ministry: *
Questions/Notes:
How did you hear about Keith Seymour or YouthMinWins? *
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