We appreciate your interest in having Teri Brinsley speak at your upcoming event.

Please take a moment to fill out and return the form below  (*all information requested on the form is required.)  It will be much easier for us to answer any questions you may have once we receive back the completed information form from you!  Once we’ve received your information, we’ll contact you to talk about the event.

In addition to the event information, please take a moment to let us know why you feel Teri would be the right speaker for your event and how you heard about her.


Ask Teri to Speak

    Personal Information

    Contact Name (required):

    Contact Email (required):

    Contact Phone (with area code, please):

    Church or Organization Information

    Church or Organization:

    Church Address:

    Church Website Address:

    Your Affiliation (with Church or Organization):

    Senior Pastor's Name:

    Women's Ministry Leader's Name (if applicable):

    Event Information

    Type/Name of Event:

    Date(s) of Event:

    Brief Description of Event (including information of any additional speakers):

    Event Location:

    Total number of attendees expected:

    Would Your Attendees Enjoy Our Resources Being Made Available at the Event?  

    If Yes, Will You Provide a Table and Area for the Resources?   

    Additional Information You Would Like To Share:

    Thank you, and we look forward to connecting with you very soon!