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Ministry Request

Ministry Request Form

Organization Name (required)

Senior Leadership (required)



Address line 2:




Zip/Post Code:



Closest Airport:

How did you hear about Julian?

Contact Person

Contact persona name (required)

Title/position (required)

Your Email (required)

Daytime Phone:

Alternative Phone (required)

Requested Dates Below (You may select up to three dates)

Requested Date 1 (required)

Requested Date 2:

Requested Date 3:

If a weekend is not available would you consider mid-week?
 Yes No

Please provide us with any notes about the requested dates below.

Event Details

Please provide us with relevant details on the events and your expectations

Number of Congregations involved (required)

Number of expected attendees (required)

Other Speakers (required)
 Yes No

Will someone be able to run our product table (required)
 Yes No

Please tell us about your ministry

Are you Human?

To make sure that you're a real person can you please fill in the captcha below