Speaking Engagement Request Form

David Agron, Ph.D.

editor@ChristianAcademiaPress.com  |   dagron@Accreditation101.com

(626) 617-0527   |  (800) 251-0255


Date of Request*

Date of Function*

Organization*

Contact Name*

Email*

Phone*


Function

Theme/Topic

Location

Audience (size, age range, etc.)

Number/length of messages

Function Schedule

Time Dr. Agron will speak

Dress code

Book Sales Table  Approved Denied

Will function be recorded?  No Yes (audio) Yes (video)
If Dr. Agron's material is recorded,
• Dr. Agron grants permission for your internal use and distribution
(e.g., copies given or sold to church members but not sold online or at other venues)
• Dr. Agron must receive a copy that can be reproduced and use with full rights


 

Compensation

Accommodations

Meals

Transportation

Method/Time of payment

Any additional information you need from Dr. Agron