SPEAKER QUESTIONNAIRE:

Please complete all areas relevant to your presentation*. You may copy and paste into appropriate areas from your own document if you already have this information available. Please complete the form below and click Submit.

1. Briefly summarize or describe your proposed talk or presentation:*
2. What is the primary message (or messages) that you intend members of our congregation to take from your presentation? (Be as specific as possible).
3. Please provide a paragraph that we may use in our newsletter and in local media, describing your background, interests or experience related to your topic or presentation; or attach a curriculum vitae underlining information that may be included.*
4. What is the title of your presentation? (The title will be used for our newsletter and local media). *
5. Our order of service includes both music and a reading. You may indicate your choices or leave the selection to the music director and the reader. If you wish to make suggestions or recommendations, please indicate below and we will contact you at least two weeks prior to the date scheduled for your presentation. Please contact me for my recommendations:

There is no need to contact me for my recommendations:
Here are some Suggestions or Recommendations:
Name:*
Email:*
Phone:*
Fax:

Address:
   
Required*