Speaking Request Form
Ministry/Organization Name
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Pastor/Host Name
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Website
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Address
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Address 2
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City
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State
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Zip
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Phone
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Email
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Ministry Event Type
Other (Please explain)
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List potential dates requested
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Event Start Time
Time
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Event End Time
Time
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Expected Attendance
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Event address (if different from above)
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Address
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Address 2
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City
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State
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Zip
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Additional event details (theme etc.)
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Contact Information (contact person)
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Last Name
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Cell Phone
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Email
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