Request a Speaking Engagement

What is the name of the event?*
In what city will the event take place?*
Event Start Date:*
Date Format: MM slash DD slash YYYY
Event End Date:*
Date Format: MM slash DD slash YYYY
If dates are flexible, please list in chronological order other potential dates:
How many times do you want him to speak?*
What specific topics are you requesting to cover?*
How long should he plan to speak for each message?*
What will be the event schedule (including the precise times of day)?*
Who is the main point of contact for this event?*
First Last
Contact Phone:*
Contact E-mail:*
What organization/church is sponsoring the event?*
What is the vision and purpose of the event?*
Who else will be speaking at this event?*
Who is the target audience?*
How many attendees do you expect?*
When do you need a formal response from him?*
Date Format: MM slash DD slash YYYY
Location/Travel Information
Event Venue Name:*
Event Venue Address*
Street Address City State / Province / Region ZIP / Postal Code Country
Which airport would he fly in to?*
Will he need to rent a car or will someone pick him up?*
What is the travel time from the airport to the event location?*
When do you expect him to arrive at your location?*
When will he be available to return to Kansas City?*
Which travel expenses will you be covering?*
To whom should reimbursements be submitted?*
Email of Reimbursement Contact:*
Phone Number of Reimbursement Contact:*
How would you like reimbursements submitted? (Email scanned receipts, Mail copies, etc.)*
Sam has no set honorarium for speaking engagements. If you do plan to include an honorarium, he does have suggested amounts for different events based on distance, travel inconvenience, whether it is occurring on a weekend, time away from family, and how many times he's being requested to speak. If you are going to offer him an honorarium, please specify the amount:*
Anything else?

Request a Speaking Engagement

Location/Travel Information

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