Church Name:

Church Address:

City Church is located:

State Church is located:

Zipcode (Church):

Church Website:

Contact Person:

Contact Person E-mail:

Contact Person Phone #:

Requested date(s) of ministry:

Service Time(s):

What type of service? (campmeeting conference etc.):

Theme name (if applicable):

Is the meeting open to the public?

Is there a registration fee?

Expected Attendance at Meeting?

Are you advertising?

What other guests will be participating in this function?

Are there any special events planned following the service?

Other Comments: