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Name of the Church or Organization

Full Address

Website http://

Contact Person - First and Last Name

Email Address

Phone Number

How did you hear about Meesh?

Date of Event (mm/dd/yyyy)

Event Location - Full Address

Theme of the Event

Event Audience:
YouthAdultsMixedMensLeadersOther

Expected Number in Attendance

When do you want Meesh to Speak? Date(s) and Time(s)?

What media capabilities are available?: (i.e. audio, video, etc)

What is the budgeted speakers honorarium for this event?

Nearest Airport

What is the distance from airport to the event?

What is the time/distance from hotel to event?

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