Loving On Purpose Ministry request form
Please use this form to request ministry by Danny or Sheri Silk.

To finish your ministry request, please complete the required information below.
Speaker Requested

Organization

Organization Name
Senior Leadership
Website
Address
Address Line 2
City
Country
State/Province
Zip/Postcode
Phone
Fax
Closest Airport
How did you hear about us?
(ex. book, Leaders Advance, conference, other leader/ministry)

Contact Person

Contact Person Name
Title/Position (ex: "Personal Assistant")
E-Mail Address
Phone Number
Phone Number 2

Requested Dates

Below you may select up to 3 possible dates.

Requested Date (1)
    Add
Requested Date (2)
    Remove | Add
Requested Date (3)
    Remove
Numbers of Days Requested  
Total Speaking Sessions  

If a weekend is not available, would you consider mid-week?

Notes about requested dates:
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Event Details

Event Name & Description
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Venue Address
Number of Congregations Involved
Expected Number of Attendees
Other Speakers
Yes   No
Names:
Product Shipping Address
(Specify ministry or venue address, or type alternate address here)
Will someone be able to help run our product table?
Yes   No
Do you have the capability of connecting an Apple laptop to a screen projector for a Keynote presentation (with audio)?
Yes   No   I Don't Know

Tell us about your ministry...

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