Speaker Request

Charles is honored to receive your inquiry and grateful that you considered him to be part of your event! Please fill out the form below as thoroughly as possible to help us in the process of reviewing and responding to your request

Complete the form to request Charles as a Speaker at your Church!

Speaker Request Form

Church/Organization

This field is required.

Event

This field is required.

Event Purpose/Theme

This field is required.

Goals
What is the goal of the program?
What would you like the speaker to accomplish?

This field is required.

Length of Time

This field is required.

Event Date

This field is required.

Speaker Arrival Time

This field is required.

Scheduled Time for Speaker

This field is required.

Honorarium (if available)

Contact Person

First Name

This field is required.

First Name

This field is required.

Last Name

This field is required.

Phone Number

This field is required.

Address

Country

This field is required.

Address Line 1

This field is required.

Address Line 2

This field is required.

City

This field is required.

State

This field is required.

ZIP Code

This field is required.

Website

This field is required.

Anticipated Attendance / Demographic

This field is required.