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 ApprovedDenied

Will function be recorded? NoYes (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