Jennifer Rothschild Speaker Request Form

Speaker Request Form

We are humbled by the many requests Jennifer Rothschild receives to participate in events. In an effort to be good stewards of Jennifer's time and gifts, we ask all event planners to complete the Speaker Request Form below.

For each request a number of factors (location, attendance, scheduling, etc.) are taken into consideration. Our speaking committee meets at least once a month - often more frequently - to plan Jennifer's calendar.

A member of our staff will follow-up with you within 3 working days with an email response. If you need someone to contact you sooner, please call 417.888.2067 sometime after you submit the information below. (back to Jennifer Rothschild home page)

Contact Information

How did you hear about Jennifer?

Contact Person		Title

Sponsoring Group

Address

City
, State/Province
Zip Code

Sponsor Organization Phone
()-

Cell Phone
()-

Home Phone
()-

Fax
()-

Website of Sponsoring Group or Event

Event Information

Days and Dates of Event
DAY
MONTH
DATES
YEAR

Main Theme or Goal of this Event

Is this a closed event to your group or church?
Yes No

Expected Size of Audience

Please give us a brief history of this event? Previous speakers, number of years in existence, past attendance, etc. Flexible dates?

Event Location

City		State
	,

Facility/Venue (enter "Undecided" if not finalized at this time)

What is the name and distance of nearby cities with major airline service?

Approximate number of times Jennifer will speak

Our budget range for honorarium is approximately:
$

Our travel expense budget is approximately:
$

Other comments, questions or information?

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