Ministry Request:

Ministry/Church Name:
Contact Name:
Email Address:
Website:
Phone Number:
Address:
City:
State:
ZIP:
Denomination or Ministry Association (If Applicable):
Event Location:
Type of Event:
Event Theme/Topic:
Projected Attendance:
Other Speakers (Please specify if Speaker is confirmed or not):
Event Dates:	-
Average Meetings Per Day:	1 2 3 4
Yes No	Will you provide the ability to display and sell our products?
Yes No	Will other congregations/denominations in the region be involved or share in the event?

Questions or Other Information:

General Contact:

Larry Randolph Ministries
PO Box 682965
Franklin, TN 37068

Tel: 615.567.6963