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Event Inquiry Request Form

Organization Name:



Organization Address:


City, State, Zip:


Contact Name:


Contact Phone:


Contact Email:


Proposed Date(s) of Presentation (list up to 3 choices):



Time of Day Presentation Will Take Place:


Desired Speaking Engagement:


Audience - who is this presentation for?:



Anticipated Attendance:



Desired Presentation Topic (choose 4 for Parish Mission Speaking Engagement):

  Four Heart Healthy Habits for Holiness

  Raising Love-Wise Kids in a Lust-full World

  Growing Up with Health & Virtue

  Mother/Daughter "Growing Up" Retreat

  Spiritual Spa Women's Retreat

  Four Secrets for Raising Kids with Character

  "The Doctor is In - Live" Q& A

  Seven Weapons for Defending Your Marriage from the Devil 

  FIREPROOF Your Marriage

  Unity or Division in Marriage

  Pro-Life and Pro-Family

  Reflections for Engaged Couples: Unity or Division?

  Preparing for Love & Life: The Chastity Challenge

  Maximum Love!
  Knights in Shining Armor and Ladies in Waiting

  Wait or Mate? A Positive Approach to Sexuality

  Chastity Education: What are we supposed to do?

  Sex Respect Teacher/Leader Training

  Love & Life Teacher/Catechist Training for Middle School or High School Teachers

  Multi-Media Youth Speaker Training for Pro-Life and Chastity Leaders

  Staff Development in the Christian Workplace

  One in Christ: Marriage Preparation Facilitator Program

  Other:  


Address of Event Venue:



Others Speakers Presenting at Event:



Name of Volunteer who will run Dr. Mast's book table:



Closest Airport to Venue:



Travel Time from Airport to Venue:



A $100 deposit is required to confirm your booking.  Please indicate desired payment method:

  Submit deposit by check

  Submit deposit by credit card (you will be directed to online payment after submitting your completed form)