Your Name:

Your Position/Title:

Telephone:

Fax:

Host Church Oganization:

Church Website:

Email Address:

Telephone Number:

Fax Number:

Address:

Provence/Country:

State:

Zip Code:

Meeting Coordinator:

Work Number:

Cell Number:

Pastor/Host:

Spouse's Name:

Pastors Residence #:
(for emergency only)

How did you first hear about Pastor S. Cornish:

Meeting Facility Information

Requested Dates of Ministry:

Meeting Location:
(if different from above)

Service Times:

Physical Address:

Telephone:

Fax:

Has Pastor Samuel Cornish ever ministered at your church?

If so when was the last time?

Theme name (Conference etc)

Expected Attendance:

Are there any special events planned following the service?

Total occupancy of meeting facility:

What type of advertising will you do?

Travel Accommodations

Will expenses be paid (including reimbursement for airline ticket for Pastor Cornish and his assistant hotel room?

Hotel Name:

Address:

Phone #:

Name of nearby restaurants:

Product Sales

May we have at least one(1) table to display and sell ministry products?

Additional details: