Speaking Request FormThank you for your interest in having me involved in your event. It is an honor that you are entrusting me with this request, and I do not take it for granted. Please fill out this form in its entirety. If there is a blank that is not applicable to your event, please enter "N/A" in the blank. I will try to respond to your request within three weeks of the time I receive it.Event InformationWhat is the name of the event? *Event Web Site:*In what city will the event take place?*Event Start Date:*Event End Date:*If dates are flexible, please list in chronological order other potential dates:How many times do you want Denny to speak?*What specific topics are you requesting Denny to cover?*How long should he plan to speak for each message?*25-30 minutes35-40 minutes45-50 minutes55-60 minutesWhat will be the event schedule (including the precise times of day Denny will speak)?*Who is the main point of contact for this event?* First Last Contact E-mail:*Contact Phone:* Area Code - Phone Number What organization/church is sponsoring the event?*What is the vision and purpose of the event?*Who, in addition to Denny, 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 Denny?*Location and Travel InformationWhat is the name of the event venue?*What is the address of the event venue? * Street AddressCityState / Province / RegionPostal / Zip CodeAfghanistanAlbaniaAlgeriaAndorraAngolaAntigua and BarbudaArgentinaArmeniaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBhutanBoliviaBosnia and HerzegovinaBotswanaBrazilBruneiBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCentral African RepublicChadChileChinaColombiaComorosCongo (Brazzaville)CongoCosta RicaCote d'IvoireCroatiaCubaCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEast Timor (Timor Timur)EcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEthiopiaFijiFinlandFranceGabonGambia, TheGeorgiaGermanyGhanaGreeceGrenadaGuatemalaGuineaGuinea-BissauGuyanaHaitiHondurasHungaryIcelandIndiaIndonesiaIranIraqIrelandIsraelItalyJamaicaJapanJordanKazakhstanKenyaKiribatiKorea, NorthKorea, SouthKuwaitKyrgyzstanLaosLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMauritaniaMauritiusMexicoMicronesiaMoldovaMonacoMongoliaMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew ZealandNicaraguaNigerNigeriaNorwayOmanPakistanPalauPanamaPapua New GuineaParaguayPeruPhilippinesPolandPortugalQatarRomaniaRussiaRwandaSaint Kitts and NevisSaint LuciaSaint VincentSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbia and MontenegroSeychellesSierra LeoneSingaporeSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSpainSri LankaSudanSurinameSwazilandSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTogoTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTuvaluUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVatican CityVenezuelaVietnamYemenZambiaZimbabweCountryWhich airport would Denny fly in to? *What is the travel time from the airport to the event location?*When do you expect Denny to arrive at your location?*When will Denny be available to return to Louisville?*Which of Denny’s travel expenses will you be covering? *AirfareLocal Transportation (Rental Car or Taxi)HousingMealsTo whom should reimbursements be submitted? *Email of Reimbursement Contact:*Phone Number of Reimbursement Contact:* Area Code - Phone Number How would you like reimbursements submitted? (Email scanned receipts, Mail copies, etc.)*Denny has no set fee for speaking engagements. But if you are going to offer him an honorarium, please specify the amount:*Anything else?Verify that you are a human:Submit FormReset Share this:TweetPocket