Contact Information (Section 1 of 4)
* Contact name:	[First MI Last]
Contact title:
Street address:
City:
State:
Zip:
* Email address:
* Email address confirmation:
* Home phone#:	[###-###-####]
Mobile phone#:	[###-###-####]
Fax#:	[###-###-####]
Event Information (Section 2 of 4)
* Event date:	[mm/dd/yyyy]
Event time:
Sponsoring organization:
Venue:
Capacity:
Attendance estimate:
Type (worship, speaking, graduation, etc.):
Speaker Responsibilities (please be brief):
Retreat or Conference Information (Section 3 of 4)
Registration cost:
Retreat/Conference description:
Have you hosted Tynesha Lewis before?	Yes No
If Yes, when and where?
Are merchandise sales O.K.?	Yes No
If Yes, can you provide 1 - 2 salespeople?	Yes No
Honorarium Information (Section 4 of 4)
Honorarium offer amount (U.S. $):
Do you agree to pay roundtrip airfare from Raleigh (RDU)?	Yes No
Do you agree to pay $.33/mile if Tynesha drives from Raleigh?	Yes No
Do you agree to pay for and arrange hotel accommodations?	Yes No
Additional comments, questions, or notes: