Please provide the following contact information:

Name
Organization
Work Phone
FAX
E-mail
URL

Event start date :

  -- mm/dd/yy

Event end date :

  -- mm/dd/yy

Type of conference:

Is Pastor Hutchins the main speaker?

Yes No

Other speakers? (e.g.. Speaker1, Speaker2, etc.)

How many plenary sessions are you requesting Pastor Hutchins to speak for?

How many workshops or breakout sessions are you requesting him to speak for?

Schedule and duration of speaking times (e.g.. Session at 9:00am on 01/01/07 for 1 hour):

Are there any particular topics you would like him to speak about in each session? (please list all)

Estimated number of attendees:

Makeup of the attendees (e.g.. age range, urban, pastors, lay leaders, church planters, ethnic diversity, etc.)

How do you know Pastor Hutchins? (e.g.. Where and when did you meet him? Who referred him to you?

Overall purpose of the conference?

Name and address of the event site:

Location of nearest airport to the event:

Is a photograph and biography of Pastor Hutchins required?

Yes No

What typical honorarium do you provide for this event?

Are you able to provide hotel accommodations and expenses for a business class flight?

Yes No

As part of Pastor Hutchins commitment to leadership development, he believes in allowing other lay leaders, staff members or family members to accompany him on his speaking engagements. Would you be willing to provide travel expenses to accommodate this priority?

Yes No

If yes, up to how many in his party?

Other notes or comments: