HOST MINISTRY INFORMATION

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Office Fax with Area Code: 

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Website Address: 

Street Address: (required) 

City: (required) 

State: (required)PLEASE SELECTAlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Marianas IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaVirgin IslandsWashingtonWest VirginiaWisconsinWyoming

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Check if mailing address is the same as above: Same

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Mailing Address: 

Mailing City: 

Mailing State:PLEASE SELECTAlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Marianas IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaVirgin IslandsWashingtonWest VirginiaWisconsinWyoming

Mailing Zip Code: 

PASTOR INFORMATION

Pastor's Name: 

Pastor's Assistant/Secretary: 

Pastor's Mobile Phone: 

Pastor's Home Phone: 

Event Coordinator's Name: 

Event Coordinator's Phone: 

Event Coordinator's Email: 

EVENT INFORMATION

Check if the event address is the same as host Same

Event Location: 

Event Address: 

Event City: 

Event State:PLEASE SELECTAlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Marianas IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaVirgin IslandsWashingtonWest VirginiaWisconsinWyoming

Event Zip: 

Nearest commercial and/or private airport? 

Approximate distance from airport to event? 

Type of Service(s):RevivalCamp MeetingConferenceSpecial GuestOther

Type of advertising for the event? 

Start Date of Event: 

End Date of Event: 

Event Time(s): 

Time Zone:PLEASE SELECTEasternCentralMountainPacificAlaskaHawaii-Aleutian

Other Event Speaker(s): 

Seating capacity (must accommodate 500+ people) 

Expected Attendance: 

Will the service(s) be recorded? Yes No

Will the service(s) be streamed "live" via the internet? Yes No

Any special event(s) following service(s)? 

Do you have a Hammond organ with Leslie speaker? Yes No Other

Do you have a wireless hand-held microphone? Yes No Other

GENERAL INFORMATION

How you heard about Pastor Bates?WebsiteFriendTVChurchWord of MouthOther

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