Organization
Organization Name (*)
required
Senior Leadership (*)
* required
Website
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Address (*)
* required
Address Line 2
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City (*)
* required
State/Province (*)
* required
Zip/Postcode (*)
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Phone (*)
* required
Closest Airport
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Prior to the event, we will ship product to the address given below.
This should be a physical address (not P.O. box) where UPS packages can be received.

Contact Person

Contact Person Name (*)
* required
E-Mail Address (*)
* required
Phone Number (*)
* required
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Requested Dates

Below you may select up to 3 possible dates.
Requested Date
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Numbers of Days Requested
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If a weekend is not available, would you consider mid-week?
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Notes about requested dates:
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Event Details

Event Description
* required
Number of Congregations Involved
* required
(enter "1" if hosting alone)
Expected Number of Attendees
* required
(please be as specific as possible)
What is the capacity of the event facility?
* required
Other Speakers
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Ministry

Below, please give a brief description of your ministry
* required
Fill in the code shown (*) Fill in the code shown
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