Form

Rebuilt Speakers Network

SPEAKING ENGAGEMENT - EVENT DETAILS

Name of Church/Organization *

Tell us about your organization.*

Organization Website *

Name of the Event*

Event Dates*

Event Location *

Will this presentation be in person? Will this be live-streamed or recorded?*

Presentation Details *

Type of Presentation: Keynote, Convocation, Breakout session, Panel, or Training

Total Number of Presentations Requested *

Number of guests expected*

Do you have a budget for this event?*

A speaker honorarium and travel reimbursement for speaker and assistant is appreciated.

Who is the intended audience?*

Clergy, diocesan or parish leaders, lay staff, business leaders, parishioners

Any additional questions or comments for our Rebuilt team:

First name*

Last name*

Postion*

Email*

Phone Number*

Thank you for completing this form! If you have questions please email colleen@rebuiltparish.com