Title of Event (required)
Phone number 1 (required)
Phone number 2
What is the name of the church, organization, school, etc. that you represent? (required)
City, State, Zip (required)
What type of participation are you requesting? (required)
Do you need someone to speak on a Special Needs Ministry topic?Do you need a Conference on Special Needs Ministry?Do you need someone to speak on a Special Education topic?Do you need a Conference on Special Education Topics?Do you need someone to set up a booth at an event you are hosting?Do you need outreach materials for an event you are hosting?Do you have another need?
What date/dates are you considering for this event? (required)
Do you have a specific existing workshop(s) in mind?
Refer to LifeLine Workshop Topic List by clicking here then please list (required)
If the topic you were looking for is not listed, on what topic will you need someone to speak ? (required)
Will this booth be indoors or outdoors? (required)
Will a table be provided? (required)
Would you like information about Special Needs Ministry? (required)
Would you like information about Special Education topics? (required)
How many attendees are expected? (required)
Where will the event be held? (required)
Thank you for considering LifeLine to speak at or participate in your event. We will be in touch as soon as possible.