Contact Person: 

Organization Name: 

Physical Address: 

Address 2: 

City: 

State/Region: 

Zip: 

Country: 

Phone: 

Email: 

Church Denomination: 

Perferred Date 1
(1=Most, 3 = Least)

Perferred Date 2: 

Perferred Date 3: 

Meeting Times 1:
(1=Most, 3 = Least)

Meeting Times 2: 

Meeting Times 3: 

Speaker Gender Preference: 

Topics: 

Willing to pay travel expenses?: 

How much?: 

Willing to pay speaking honorarium?: 

How much?: 

Willing to take a love offering?: 

Estimate?:


 
PLEASE READ:  This is an initial booking request form.  Your request will be forwarded to the speaker who is closest to your area and criteria.  If he/she accepts your terms, you will be sent a final booking email.  This email will have a link to PayPal or a mail-in payment form.  If you are not signed up for PayPal, please do so here:

Upon receipt of your $25.00 booking fee at PayPal or by mail you will be given the full contact information for the speaker.  It will then be your responsibility to make further arrangements in keeping with what you have submitted on this form.  This form constitutes a binding agreement between you, the speaker and ACT upon final acceptance.  The booking fee is non-refundable, but will only be paid when both parties have agreed to the booking.  This form sets forth your criteria to book the speaker.  When we send you the email saying we have a speaker chosen for your date and criteria, you may at that time accept or decline the speaker before paying the fee.  If you accept the speaker and pay the fee to PayPal or by mail you are obligated to carry through with the arrangements for the meeting as agreed upon by all parties.

We hope that this form will bring an excellent speaker to your church or organization, and we are trusting that the Lord Jesus Christ will bless you mightily through this endeavor.

Please press the "Submit By Email" button to send this form to ACT.  Press the "Reset" button only if you wish to clear the entire form and start over.