Please fill out and submit this form electronically for all speaking and event booking requests. Christine will be back in contact with you as soon as possible to discuss your needs and confirm your date(s).

*(denotes required field)

First Name:*

Last Name:*

E-Mail Address:*

Church/School/Organization

Campus/Department Name

Your Title/Role

Best phone number to use and time of day to contact you

What speaking event are you most interested in?

Church-Women Stand Up! Church-Sunday morning message Church-BraveHearts Conference Church-other Campus-Seduce me. Campus-Women Stand Up! Campus-other

Expected Attendence

<250 250-500 500-1000 1000-2500 2500+

1st Choice Date

2nd Choice Date

3rd Choice Date

Time of day I’d be speaking

AM PM Both

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