Speaker Questionnaire

General Information

Date

First Name

Last Name

Ministry Name

For tax purposes, which name should appear on the honorarium disbursments?

Individual

Ministry

Social Security or Tax ID number

For tax purposes, is this a social security or tax ID number?

Social Security

Tax ID

Street Address

City

Postal / Zip code

Region/State/Province

Office Number

Mobile Number

Spouse's First Name

Spouse's Last Name

What is the best address to deliver a "Thank You" gift to your spouse while you are in Idaho?

Spouse's Phone

How many people will be traveling with you?

Names and ages of those traveling with you?

What form of transportation will you be taking?

Flying

Driving

Airline and Flight Number

Arrival Date

Departure Date

Arrival Time

Departure Time

Speaker Needs

Media Needs

Sermon Props/Illustrations

Any Other Sermon Needs

As a Guest Speaker I understand that presentation may be videotaped or recorded, for the purpose of being used and distributed for informational, educational or entertainment purposes. I give my permission and authorize the Southern Idaho District to videotape, audiotape, photograph, record, edit or otherwise reproduce my presentation.

Yes

Your Signature (I understand this is a legal representation of my signature.)

Favorite Foods

Favorite Snacks/Drinks

Intrests/Hobbies

Is there any other informaiton we need to better serve you?

Thanks for submitting!

Speaker Questionnaire

General Information

Speaker Needs

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