Speaking Engagement Request Form

Please fill in all entries below and press submit


Ministry Name:
Pastor Name:
Church Address:
State Zip:
Church Phone:
Contact Person:
Contact person Number:
Fax #:
Date of Event:
Is Event being held at your Church, If not please list address below :

Requested Speaker?
Bishop Jerome A.Taylor 
Name of Event:
Is this your Church Anniversary?  yes no
Time of Event:
Is there a Dress Code?:  yes no
Does your church have a CD/DVD player?  yes no
Does your church have a sound system?  yes no
Does your church have a stage? yes no
Is there a time frame?: yes no
Scripture Reference:
Theme or Topic for Event:

Bishop Jerome would like to thank your ministry for inviting
him out to speak. His bios can be retrieved from our web site,

A sealed bottle of Aqua fina water at room temperature
while ministering. ( Bishop Jerome )
No Pork or seafood on menu.
Bishop Jerome prefer to
drink 100% fruit juices with his meals.
Bishop Jerome will receive a
love offering of what ever the Lord lays upon your hearts to give.

Please mail or fax all information to:
Heart to Heart International Ministries
P.O. Box 1938 Moncks Corner, SC 29461
Attention:Sis. Fiona Varner PA
Phone 843 345 0519 Fax 843 899 0877

I agree that all the info listed above is accurate to the best of my knowledge.
I understand that I am responsible to inform you of any changes that might
occur in regards to this engagement schedule.