Name of Church/Organization*

Name of Pastor (If Applicable)

Mailing Address of Speaking Engagement Location*

Location Phone Number*

CONTACT PERSON INFORMATION
Name of Contact Person*

Contact Phone Number*

Contact Email Address*

Contact Mailing Address*

City*

State and Zip Code*

Preferred Speaking Date(s)*

Select Which You Prefer*
Sunday Worship ServiceSunday SchoolHome GroupEvening ServiceOther
Time of Meeting*

Start Time & Length of Speaking Engagement*

Purpose For Request

Special Topic

Audience Size/Age*

Video Projector Available For Speaker?*

What is the Appropriate Attire for the Speaker?*

Can SOM Promote this Speaking Engagement on the Web and Email?*

The Sunday morning worship/home group service message will give a global perspective of what God is doing through the "living martyrs" in restricted areas of the world.
Please Read and Check Box:
Please understand the financial responsibility involved in having a representative travel and speak. We seek to always be able to cover the cost of travel and lodging in some way. Although we do not ask for an honorarium, we trust the Lord that expenses would be offset by a donation or love offering designated to SOM International.