Contact Person:

Organization/Church:

Address:

Phone:

Email:

Event Dates:

Best method for reaching you:

Website:

How did you hear about us?:

Event Name:

Event Location:

Event Theme:

Objectives of this event:

Message(s) or topic(s) requested:

Number of presentations:

Length of presentation(s):

Audience Demographic:

Estimated Attendance:

Is there PowerPoint capabilities:

Is there booth space available:

Sales of Eternal Impact products okay:

Can we have a table with Eternal Impact information available:

Will there be volunteers to help run the table if our staff is not there:

Can we put anything on your website:

Will there be an honorarium:

If yes, amount budgeted:

Travel Expenses: