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Couple Checkup Conference
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Couple Checkup Conference

Conference Request Form

 

 

If you have read the Conference Planner and are ready to bring the Couple Checkup Conference to your area, please submit the following request form.  Once we receive your request we will acknowledge it with an email.  Ron's speaking team then evaluates each request before contacting you to dialogue about your goals and explore available dates.  All fields are required information. 

Your Name   

Title or Position   

Phone Number  

E-mail address  


Church/Company Name
(if a church, what is your 
average weekend attendance?)

Address 

City (and population) 

State 

Zip 

 

Phone   

Web Site  

What is the nearest major city? 
Distance to nearest airport? 

 

Briefly describe the mission
of your department.

What role will the conference
play in your strategic plan? 
Will this be a community event or an
"in-house" training?

Have you or someone from your
planning team ever attended one of
Ron's conferences before?

 

Yes
No

What other conferences/seminars have
you hosted in the past and
what was the average attendance?

What is your preferred conference date? 
(List preferred month, then possible dates.)

List a second and third choice as well: 

What kind of advertising do you plan
to use to promote this conference? 
What is your budget for advertising?
What is your ideal minimum attendance?
 

Will you be co-sponsoring this event
with any other churches/groups? 

Yes
No

If "Yes" above, who will
you co-sponsor with?

Verification Code
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