Partners Conference Speakers | Summit Ministries

Speaker *

First Name Last Name
Organization
Speaker's Cell Number *

Phone Number
Office Number

Phone Number
Preferred Email *
Brief Bio (100-300 words) *

This will be used for your introduction. 0/450
Please upload your signed "Faculty Agreement"

Upload "Faculty Agreement"
Or email krystan@summit.org with your signed "Faculty Agreement." Cancel of
Will you be using a PowerPoint presentation? *

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Are video or audio files a part of your presentation? *

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A/V needs & Comments
Please submit travel receipts for reimbursement to krystan@summit.org with an invoice and your receipts.

Summit will send a check through the mail.
Make check payable to (name or organization)
The name/organization must match what's listed on the W9.
Address for Honorarium

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code Country
Event contact:
Krystan Clupny

e-mail: krystan@summit.org | cell: 505-604-7117
941 Osage Ave. Manitou Springs, CO 80829

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