Speaker Request Form

Thank you for considering us for your event.

At Shekinah Glory, we welcome the opportunity to share God's Word with diverse communities.
To help us facilitate your request, please complete the Speaker Request Form below with as much information as possible.

If you have any questions or require assistance completing the form, please call the Shekinah Glory Administrative office at
336-914-5095.

Thanks,
The Shekinah Glory Adminstrative Staff

Speaker Request Form

Event Organizer's First Name

Event Organizer's Last Name

Event Organizer's Email

Event Organizer's Phone Number

Organization or Church Name

Address of the Event

Type of Event

Please provide the name(s) of the speaker(s) and/or auxiliary that you are requesting for this event?

Event Theme

Event Date(s)

Event Start Time

Do you require a picture of the Speaker?
Yes
No

Do you require a Biography of the Speaker
Yes
No

Additional Information About Your Event.

Submit