Speaking Request Name* First Last Email* Cell Phone*Work Phone*Date of Conference/Speaking Engagement*Address of Conference/Speaking Engagement* Street Address Address Line 2 City State / Province / Region ZIP / Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAntigua and BarbudaArgentinaArmeniaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBosnia and HerzegovinaBotswanaBrazilBruneiBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaColombiaComorosCongo, Democratic Republic of theCongo, Republic of theCosta RicaCôte d'IvoireCroatiaCubaCuraçaoCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEast TimorEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEthiopiaFaroe IslandsFijiFinlandFranceFrench PolynesiaGabonGambiaGeorgiaGermanyGhanaGreeceGreenlandGrenadaGuamGuatemalaGuineaGuinea-BissauGuyanaHaitiHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsraelItalyJamaicaJapanJordanKazakhstanKenyaKiribatiNorth KoreaSouth KoreaKosovoKuwaitKyrgyzstanLaosLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMauritaniaMauritiusMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew ZealandNicaraguaNigerNigeriaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPolandPortugalPuerto RicoQatarRomaniaRussiaRwandaSaint Kitts and NevisSaint LuciaSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSpainSri LankaSudanSudan, SouthSurinameSwazilandSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTogoTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTuvaluUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVatican CityVenezuelaVietnamVirgin Islands, BritishVirgin Islands, U.S.YemenZambiaZimbabwe Country If there is an event coordinator or contact person for the Conference/Speaking Engagement, please provide that person's name, cell phone and email address.Phone of Conference LocationNumber of People Expected to AttendTheme of Conference/Speaking EngagementWill you require Stu's bio and/or photo? Yes, Both Bio only Photo only No Subject or Topic You'd Like Addressed*Will Stu be the Main Speaker?* Yes No Number of Times Stu Will be Speaking*Length of Time Stu Speaks (i.e. 30-40 minutes)*Exact Time(s) Stu Speaks (i.e. 9 AM, 7 PM)*Who are the other speakers at the event?Recommended Dress Attire Dress Casual Dress Casual Honorarium (speaking fee only)*Travel Expenses to be Reimbursed Hotel Airfare Rental car/fuel Food Travel for assistant Other Expenses to be Reimbursed (i.e. parking, shuttle, taxi, etc.)If Stu is being met by a representative at the airport, please provide that person's name, cell phone and email address.Recommended AirportRecommended HotelAre there any special gatherings during the event that Stu would be invited to or need to be aware of? (i.e. Speaker's lunch, Pastor's dinner, etc.)Where should Stu go when he arrives at the event?If Stu is to meet a representative from the event when arriving, please provide that person's name, cell phone and email address.What is the date(s) and time(s) of mic check?*Please provide any additional information that you feel is pertinent.