CPYU Speaker Request Form

Due to the large number of requests we receive for on-site speaking and seminar engagements, the Center for Parent/Youth Understanding has established a screening process to help us discern and manage our seminar/speaking schedule. While we would like to be able to fulfill all speaking/seminar requests, we are unable to do so. In order to allow our staff an opportunity to give prayerful and serious consideration to your request, we are asking you to complete the Seminar Request Form in its entirety. After receiving your completed form, we will contact you regarding seminar/speaker availability for your requested dates. Thanks for your interest in CPYU!

Sponsoring Organization Information

Organization Name:
Address Line 1:
Address Line 2:
City: State: Zip:
Country:
Phone:
- -
Fax:
- -
Email:

Contact Person:
Phone:
- -
Fax:
- -

Event Information

Which seminar speaker would you like to request?:
What is the title of the seminar you are requesting?
Name of Event:
Location: State: Zip:

Date(s) of Event:

First Choice:
/ /   to   / /
Second Choice:
/ /   to   / /
Third Choice:
/ /   to   / /

Number of Sessions:
    Length of Session(s):   hrs.
Number of people expected:  
Amount budgeted for Honorarium:  $ 
Amount budgeted for Travel/Accommodation Expenses:  $ 

Describe your target audience. Who is likely to attend? Is it youth workers, parents, educators, teens, pastors, etc?

Are there specific topics you'd like addressed in the seminar?

Will the event be a cooperative effort with other churches/schools/etc?

What are your hopes for this event?

How does this event fit into your overall ministry strategy and objectives?

What type of publicity will you use?

How did you hear about CPYU?