Name of Contact Person*

Email*

Church/Organization Name*

Website*

Address

Street Address*

Address Line 2

City*

State/Province

Country*

Zip

Phone*

Event Type*
---Pastors and Leaders ConferenceYouth ConferenceMen's ConferenceOther (Specify Below)

If other, please specify:

Date Request(Only One is Required)

First Choice*
Month---JanFebMarAprMayJunJulAugSepOctNovDec Day ---12345678910111213141516171819202122232425262728293031 Year ---201220132014201520162017201820192020

Alternate Date #1
Month---JanFebMarAprMayJunJulAugSepOctNovDec Day ---12345678910111213141516171819202122232425262728293031 Year ---201220132014201520162017201820192020

Alternate Date #2
Month---JanFebMarAprMayJunJulAugSepOctNovDec Day ---12345678910111213141516171819202122232425262728293031 Year ---201220132014201520162017201820192020

How many times will Pastor Benny be preaching? (Include all breakout sessions.)*

Additional Information

Church Size/Expected Attendance*

Expected Honorarium*

Pastor Benny does not require a set amount for an honorarium. We ask the church/organization to believe with us for our weekly budget to be met to support our growing staff, as our ministry is completely funded by love offerings.

Please describe your event.*

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