Dates Requested

Specific
Open

Church/Event name
and brief description

Proposed function/role
(leading worship, teaching, other)

Who else will be speaking
or leading worship?

Target Audience

Have you ever organized
an event before?
Yes
No

If yes, describe briefly

Number of seats at event location

Number of expected participants

Contact Name

Position

Phone

Cell

Fax

Email

Senior Pastor/Event Director

Event Location

City

State

Zip

Website

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