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Church or Organization Name
*
Physical Address
*
Street Address
Address Line 2
City
State / Province / Region
ZIP / Postal Code
Afghanistan
Åland Islands
Albania
Algeria
American Samoa
Andorra
Angola
Anguilla
Antarctica
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Bonaire, Sint Eustatius and Saba
Bosnia and Herzegovina
Botswana
Bouvet Island
Brazil
British Indian Ocean Territory
Brunei Darussalam
Bulgaria
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Burundi
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Cameroon
Canada
Cayman Islands
Central African Republic
Chad
Chile
China
Christmas Island
Cocos Islands
Colombia
Comoros
Congo
Congo, Democratic Republic of the
Cook Islands
Costa Rica
Côte d'Ivoire
Croatia
Cuba
Curaçao
Cyprus
Czechia
Denmark
Djibouti
Dominica
Dominican Republic
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
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Eswatini
Ethiopia
Falkland Islands
Faroe Islands
Fiji
Finland
France
French Guiana
French Polynesia
French Southern Territories
Gabon
Gambia
Georgia
Germany
Ghana
Gibraltar
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Greenland
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Guam
Guatemala
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Guinea
Guinea-Bissau
Guyana
Haiti
Heard Island and McDonald Islands
Holy See
Honduras
Hong Kong
Hungary
Iceland
India
Indonesia
Iran
Iraq
Ireland
Isle of Man
Israel
Italy
Jamaica
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Jersey
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Kenya
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Korea, Republic of
Kuwait
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Latvia
Lebanon
Lesotho
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Macao
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Martinique
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Mexico
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Mongolia
Montenegro
Montserrat
Morocco
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Myanmar
Namibia
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Netherlands
New Caledonia
New Zealand
Nicaragua
Niger
Nigeria
Niue
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North Macedonia
Northern Mariana Islands
Norway
Oman
Pakistan
Palau
Palestine, State of
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Pitcairn
Poland
Portugal
Puerto Rico
Qatar
Réunion
Romania
Russian Federation
Rwanda
Saint Barthélemy
Saint Helena, Ascension and Tristan da Cunha
Saint Kitts and Nevis
Saint Lucia
Saint Martin
Saint Pierre and Miquelon
Saint Vincent and the Grenadines
Samoa
San Marino
Sao Tome and Principe
Saudi Arabia
Senegal
Serbia
Seychelles
Sierra Leone
Singapore
Sint Maarten
Slovakia
Slovenia
Solomon Islands
Somalia
South Africa
South Georgia and the South Sandwich Islands
South Sudan
Spain
Sri Lanka
Sudan
Suriname
Svalbard and Jan Mayen
Sweden
Switzerland
Syria Arab Republic
Taiwan
Tajikistan
Tanzania, the United Republic of
Thailand
Timor-Leste
Togo
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Tonga
Trinidad and Tobago
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Turkmenistan
Turks and Caicos Islands
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Uganda
Ukraine
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Uzbekistan
Vanuatu
Venezuela
Viet Nam
Virgin Islands, British
Virgin Islands, U.S.
Wallis and Futuna
Western Sahara
Yemen
Zambia
Zimbabwe
Country
Please note: We prioritize speaking engagements in North America.
Contact Name
*
Dr.
Miss
Mr.
Mrs.
Ms.
Prof.
Rev.
Prefix
First
Last
Phone
*
Email
*
Is your church/organization a current supporter of the Chalmers Center?
*
Yes
No
Do you have plans to call the audience to respond practically to the message presented at your event?
*
Yes
No
I’m not sure what you mean by this.
What is your church/organization's denominational affiliation?
*
Event Details
First Preferred Date
*
Second Preferred Date
*
Event Location
*
Describe the vision, purpose, and/or theme of the event.
*
What is the specific role and message content you envision for Brian for this event?
*
Are you open to an alternate speaker from the Chalmers Center if Brian is not available?
*
Yes
No
Who is the audience for this event?
*
What is the expected attendance at this event?
*
Will the event site have appropriate A/V set-up and personnel?
*
Yes
No
Please note: Because we use visual diagrams to illustrate key concepts, an easily-visible LCD video projection system to display presentation slides and voice amplification that enables everyone to hear well are necessary. Presentations may include videos, so the A/V system needs to be adequate for playing video files (MP4, MOV, or streaming from Vimeo). We ask that hosts have a qualified A/V contact perform a pre-event test display of the slides and sound check. Except in extremely rare cases, the presentation will be played from the Chalmers Center’s MacBook or MacBook Air computer, controlled from a USB connected pointer. If this is not possible, please let us know at least 2 months in advance of the event.
Please provide as detailed an event schedule as possible. You may upload a schedule document if you prefer.
*
Please include: Scheduled times Brian would speak; Meetings you would like Brian to attend; Meals Brian is invited to; How long his message(s) should be; If there will be other speakers at the event; and any other relevant details.
Schedule Document(s)
Drop files here or
Select files
Accepted file types: pdf, doc, txt, Max. file size: 512 MB.
Travel / Transportation
Closest airport to event location:
*
Approximate travel time to event location from airport:
*
Is your church/organization able to reimburse the Chalmers Center for Brian's travel expenses: airfare, hotel, meals, rental car (if needed)?
*
Yes
No
Please note: When Brian travels, we do our best to purchase the most reasonably priced airfare, etc. Because Brian is 6′ 10″ tall, he needs to have economy plus or first/business class seating on flights lasting more than 2 hours. Reimbursable travel expenses (within the U.S. and Canada) will not exceed $1,250.00 unless agreed upon in advance.
Other Information
What opportunities would be provided at this event for Brian to speak specifically about the work of the Chalmers Center and its financial needs?
*
Would the Chalmers Center be permitted to set up a display and offer resources to event attendees?
*
Yes
No
The host agrees to provide the Chalmers Center with an accurate count of event attendees and to respond to evaluation form(s) sent by the Chalmers Center after the event.
*
I/we agree.
Brian's message(s) may not be recorded/redistributed without direct written consent of the Chalmers Center.
*
I/we agree.
Please provide any other information about the event, along with any questions you may have.