Thank you for your interest in Mr. James Muffett speaking to your group. Please complete this form. If you should have any questions or suggestions, please feel free to call SSI at 1-877-464-6388. Thanks again!
Contact Name:
*
Group Name:
*
Contact Information
Address Line 1
*
Address Line 2
City
*
State
*
Zip Code
*
Phone Number
*
Email Address
Venue Information
Venue Physical Address
*
Venue Phone
*
Venue Additional Info (i.e., which entrance):
Date of Event
*
-
Month
-
Day
Year
at
/
Hour
Minutes
AM
PM
Begin Time
Time Allotted
Honorarium/Offering/Expenses ($500.00 - negotiable)
Purpose of the Event
Desired Topic
*
The Greatest Story Never Told
Ambassadors for Christ
Transferring Truth to the Next Generation
Religious Freedom & Public Schools
Hijacked History
A Christian Approach to Culture
Pursue Your Passion
A Reason for the Hope
We Have a Destiny
Building a Biblical Worldview
Makeup of Audience
Estimated Attendance
Equipment: If applicable, Mr. Muffett brings his own laptop & projector if needed; please supply electircal, screen, and sound amplification.
Further Notes/Questions:
Please type what you see in the box for "human" verification:
*
Submit
Clear Form
Should be Empty: