Request A Speaker

Your Congregation's Name

Your Name

Email Address

Date(s) Requested

Address of Venue

Address

City/Town

State/Province

ZIP/Postal Code

We are part of the

Number of Worship Services

Expected attendance, including all services

Would you like a speaker for an adult forum?

Yes

Please detail, if any, the special theme or focus for worship:

	What best describes your congregation?
	My congregation is new to LWR, and we'd like someone to come and tell us more about your work and how we can get involved.
	Someone from my congregation recently heard an LWR speaker at another event, and we want to bring that same inspirational message back to our congregation.
	My congregation has been involved with LWR in the past, but we're interested in more ways to engage.
	My congregation is very familiar with LWR and we'd like to personally connect with an LWR staff member and share our stories.

	What other ways does your congregation connect with LWR?
	My congregation is a contributor to LWR's Quilts and Kits Ministry
	My congregation is involved with LWR Farmers Market Coffee
	My congregation holds special offerings to raise money for disaster relief
	Other

Are you able to cover travel costs?

Yes

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