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 Number of Services*Length of Speaking Opportunity*Speaker 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 Sermon vs Presentation* Sermon Presentation Microphone Type* Podium Mounted Mic Lavalier Mic Stand Mic Handheld Mic No Mic Will there be a podium or music stand?* Yes No Bible Version*Will the service be recorded and played/live streamed?* Yes No May the speaker play a video?* Yes No Has a video been played previously? Yes No If yes, which video?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 Volunteer Other Audience Type* Sunday Morning Elementary Students Youth Group/Teen College Students Seniors Civic Group Women's Group Men's Group Other Style of Dress?*Estimated Number of Attendees*Campaign History LIFEday LIFEchange Walk for LIFE MGE Host Other Amount raised from most recent LIFEchange campaign*How many years has this church participated in LIFEchange campaigns?*Who is the LIFEchange campaign contact for this church?*Amount raised from most recent Walk for LIFE campaign*How many years has this church participated in Walk for LIFE campaigns?*Who is the Walk for LIFE campaign contact for this church?*Please provide details about the campaign this church participated in*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
