Speaker Event Details "*" indicates required fields Name of Submitter* First Last Event Contact Person* First Last Event Contact Person Phone*Event Contact Person Email* Preferred Contact method(check all that apply) Email Phone Text Event Date* MM slash DD slash YYYY Church or Organization*Church's Website* Supporter ID*Event Address* Street Address Address Line 2 City StateAlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Indoor vs. Outdoor* Indoor Outdoor Both If outdoor, will there be a tent or other type of covering?*Event Start Time* HH : MM AM PM AM/PM Event End Time* HH : MM AM PM AM/PM Speaker Arrival Time* HH : MM AM PM AM/PM Length of Speaking Opportunity*Select one2 mins3 mins5 mins10 mins15 mins20 mins25 mins30 mins35 mins40 mins45 mins50 mins1 hour1.25 hours1.5 hours1.75 hours2 hoursSpeaker Instructions*AV Contact PersonAV Contact is the same as the Primary Event Contact Person. AV Contact is the same as the Primary Event Contact Person. AV Contact Person* First Last AV Contact Person Phone*AV Contact Person Email* Date AV files are needed* MM slash DD slash YYYY Microphone Type* Podium Mounted Mic Lavalier Mic Stand Mic Handheld Mic No Mic Will there be a podium or music stand?* Yes No AV Formats AcceptedSelect all preferred formats. JPG 3:4 Screen Ratio MP4 video file PNG 9:16 Screen Ratio YouTube link Will the service be recorded and played/live streamed?* Yes No May the speaker play a video?* Yes No CPC Info Table Yes No Info Table Setup Provided Table Chairs Tablecloth Request Justice the LIFE Lion?* Yes No Is a volunteer from the church available to wear the costume? Yes No Event Focus CPC (General) Walk for LIFE Keim LIFEday Mission Great Expectations Missions Conference School Chapel Audience Type* Sunday Morning Children's Church Elementary Children's Church Middle Youth Group/Teen College Students Seniors Civic Group Other Style of Dress?*Bible Version*Estimated Number of Attendees*Church History*Prior Speaker History* Yes No Unknown Prior Speaker*Did this church have an Ambassador last Walk for LIFE? Yes No N/A Prior Walk for LIFE AmbassadorChurch's MR*Anything else of note?Speaker*Speaker's Email* Info table managerAdditional staff memberEmailThis field is for validation purposes and should be left unchanged. Δ
