Speaking Request

Thank you for considering Pastor Mike for your event/service!

If you would like to schedule a time for Pastor Mike to speak at your Church, Event, and/or to your Leadership Team please fill out the form below.

Host Church / Organization Name: *

Senior Pastor's Name(s) *

Events Address *

Address Line 1

Address Line 2

City

State

Zip Code

Email *

Phone *

Website / URL *

Senior Pastor's (Main Contact's) Assistant: *

Contact's Email *

Contact's Number *

Event's Name *

Events Date / Time *

Date

Time

Audience (Example: Church/Youth/ Pastors/ Business/Church Staff) *

Expected Attendance *

Speaking Topic & Length *

Dress Code *

Pastor Mike & our Elders have discussed that it is appropriate for him not to travel alone. On most trips, he will bring an assistant with him. Are you willing to provide accommodation for Pastor Mike and his assistant? (We prefer Pastor Mike to be accommodated in hotels and not in private homes.) *

Are you willing to reimburse Bloom Church for travel items that may include: flights, hotel, car rental and meals for Pastor Mike and his travel assistant? *

While many speakers may have set honorariums, Pastor Mike does not. Please know that he does not base his decision around the size of the honorarium. Please indicate any predetermined amount: *

Please provide any additional comments: