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DeMonica D. Gladney
P.M.B. #227
8325 Broadway, Suite 202
Pearland, TX 77581

Email: [email protected]
Facebook: www.facebook.com/dgladney

To schedule a speaking engagement or book signing, complete and submit the online form below.
Downloadable Speaking Engagement Request Form.

SPEAKING ENGAGEMENT REQUEST FORM

Church/Ministry/Organization Information
Name: *
(Church/Ministry/Organization)

Pastor's/Leader's Name:

Spouse's Name:
Denomination/Affliation:
   
Contact Information:

Address:

*
City: *
State: *
Zip: *
Phone Number: * (ie: xxx-xxx-xxxx)
Fax Number:
Email Address: *

Website:

Event Coordinator:

Phone Number:

Alternate Contact Person:

Phone Number:

   
Event Information:
Name/Type of Event: *
Date/Time of Event: *
Location of Event: *
Theme of Event:
Attire of Event:
(e.g., semi-formal, casual)
Type of Speaker Needed:
(e.g., keynote, workshop)
Alloted Speaking Time:
min (specify minutes)
Proposed Honorarium Amount:
Estimated Number of Attendees:
Other Special Guests:
Event will be Advertised: Yes (when )
Type of Advertising:

Radio TV Print Flyers Other

   
Media Information
Speaker Media Table Setup at Event: Yes If yes, set up time:
No
Volunteers Available to Work Media Table Yes No
Audio/Videotaping of Event:

Yes ( Tape CD DVD)
No

Copies Available at End of Event Yes No
 
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