Rodman Street Missionary Baptist Church

SPEAKING ENGAGEMENT REQUEST

Ministry / Organization Information

Ministry/Organization Name

Pastor/Host First Name

Pastor/Host Last Name

Phone Number

Address

Apartment, suite, etc.

City

State

Zip/Postal Code

Event / Engagement Information

Event Name

Event Category

Please Specify (if other)

Event Address (If Different From Above)

Date Requested

Event Time

Is Date and/or Time Flexible

Date is Flexible

Time is Flexible

Both are Flexible

Event Contact First Name

Event Contact Last Name

Any Other Information or Details

Choose All That Applies

First Time Requesting Dr. Canady

Previously a Guest Speaker

Previously a Guest Facilitator

Prior Connections to Rodman St. Missionary Baptist Church