Speaker Request Form
For Dr. Jim Shields

Email(Required)

Phone(Required)

Name(Required)

First Last

For what worship service/ event are you requesting me to speak?(Required)

Church Name or Organization Name(Required)

Church or Organization Address(Required)

Street Address State / Province / Region ZIP / Postal Code

Event Date(Required)

Event Time(Required)

What do you typically wear when you are preaching?(Required)

From which Bible translation do you typically preach?(Required)

Do you want me to preach a theme / series / or particular passage of Scripture?(Required)

Is there any other information that would be helpful for me to know about the worship service / event?(Required)