We’d like to Schedule a Seminar

First Name:
Last Name:
Church Name :
Church Address:
City:
State:
Zip:
Church Phone and Extension Number:
Home Phone:
Cell Phone:
Email Address:
Web Address:
BEST TIME TO REACH YOU:
Are you?
Paid Minister Lay Person
If you are a paid ministry leader enter your position and title:

Have you hosted a Seminar for you church?
Yes No
If “yes”, what speakers have you hosted?

Briefly explain the format, materials used and your over all thoughts about that experience.

EVENT CHOICE
Name of the Requested Speaker:
Name of Seminar you would like to host:
Day of the week you would like to host the event :
Day of the week second choice:
First Date Choice:
Second Date Choice:
Third Date Choice:
This is our OWN EVENT. The title of our EVENT is:

Briefly describe the kind of event and time preferences:

CHURCH LEADERSHIP TEAM:
Name of Sr. Pastor:
Phone Number:
E-mail:
Name of Pastor who will oversee the event:
Pastor’s Title:
Phone Number:
Email:
Event Contact Person:
Title:
Phone Number:
Email: