Speaking Request Form

* Denotes Required Field

First Name *

Last Name *

Your Email *

How many times and for how long would you like Kim to speak? *

What is the topic you are requesting Kim to address? *

Name of church or organization: *

Contact Person's title or relationship to the above organization *

City, State where event will be held *

Please describe the type of event you are having *

Will there be music, breakouts or other keynote speakers included in your event? If so, please list. *

Will this be promoted as a community-wide event or will it just be for your group? *

How many are you expecting to attend the event and what is the typical age range? *

What is the start date of the event? *

What is the start time of the event? *

What is the end date of the event? *

What is the end time of the event? *

Will your team be available for a pre-event conference prayer call with Kim? *

May Kim bring books to sell at this event? *

Additional Information:

  1. looking forward to hearing from you soon.

  2. Posted by Kimberly Wagner

    Hello Luane ~

    Did you fill out a “speaker request form?” If so, we’ve not received it. Did you push the “send” button after filling out the form above? If so, it should’ve come to the website’s email address, but we’ve not received a request in the inbox. Please feel free to connect by sending an email to the site administrator: mollys1@comcast.net or try filling out the form again and be sure to push the “send” button before leaving the page. Thanks!

    Hope to hear from you, soon ~

  3. Posted by Renea Keck

    Looking for a speaker at our church for a women’s coference. Please contact me at 870-612-0576

    • Posted by Kimberly Wagner

      Hello, Renea ~

      Thank you for your inquiry. It would be helpful if you could fill out the questions on the “Speaker Request Form” (above) and push send. We can connect after that.

      Thank you so much!

  4. Posted by Carissa Din


    I was just wondering how long it usually takes to receive an answer about whether or not you would be able to speak? I sent in the request form, and I just wanted to check. Thank you!

    • Posted by Kimberly Wagner

      Hello, Carissa ~

      You should have a response in your inbox by now, if not, please check your SPAM folder. Thank you so much for your invitation, I share more in my personal email to you.

      Grace and peace, friend ~

  5. We are a small evangelical church plant in Dallas, TX and are looking to hold our first women’s retreat and are seeking a solid Biblical speaker to encourage ladies to dig deeper into the Word. I tried filling out the above form, but it kept having an error pop up. Would love it if someone contacted me back. Thank you!

    • Posted by Kimberly Wagner

      Hi, Hannah ~

      I sent you an email. If you didn’t get it, you might check your Spam folder.

      Look forward to hearing back from you, blessings ~

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