Tanda Canion. Ministry Request Form -Out of Town

Ministry Request Form (Out-of-Town)

Please fill out this form completely. Incomplete information will delay processing. Form will not be submitted without required information. If items does not apply, please skip to the next item.

Church Information

Please provide information regarding your ministry to that we can better serve you.

Church/Organization Name*

Pastor'/Organization Director

PrefixFirst NameLast Name

Church/Organizaion Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry

Church Phone*

Area CodePhone Number

Church Fax*

Area CodePhone Number

Contact Information

Please provide contact information

Full Name*

PrefixFirst NameLast Name

E-mail*

Phone Number*

Area CodePhone Number

Alternate Contact Name

First NameLast Name

Alternate Contact Email

Alternate Contact Phone Number

Area CodePhone Number

The Service

Please Provide details about the service

Please provide ministry dates (Include day(s) and time(s). Ex: April 12, 2011 at 7:00pm)*

Type of Service*

Please specify*

Theme

Please list any additional speakers.

Please provide expected attendance. (This will allow us to properly prepare our ministry product).*

Special attire/color requested? If so, please describe.*

Location of Service*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry

Honorarium

*Please provide details about the speakers honorarium to avoid any miscommunication or division as stated in

I Corinthian 1:10

Is the honorarium a percentage or set amount. ( Additional offering will not be raised if specific honorarium is established unless prior discussion). Please specify amount or percentage.*

Would your ministry like for Dr. Canion to raise the offering?*

Yes. (Please review previous information)NoUndecided

Travel Accomodations

Please provide information regarding the speaker's travel arrangement. Please note: If speaker is required to travel more by car 1.5 hours or more, speaker request that host ministry provide a rental car and gas allotment(negotiable). Depend on schedule and distance, airline ticket is required. Delta is the preferred airline (Account #2320977172).

*ALL TRAVEL (AIR/RENTAL) NEED TO BE BOOKED THROUGH DR. CANION PERSONAL BOOKING AGENT Richard Schutkin.

(Toll-Free) 1-800-776-7011, (Office) 414-769-4800

If rental car is decided by TCM, please list gas allotment.*

Hotel Accomodations

Please provide hotel information for the speaker

Hotel Name*

Hotel Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry

Hotel Phone Number*

Area CodePhone Number

***Please ensure that the hotel room key is available upon Dr. Canion arrival to avoid having to stop at the front desk.***

Note: For Out of State Travel, Please provide the following.

*Meals

*Ground Transportation

*Personal Greeter (To greet Dr. Canion at the airport or upon arrival)

Personal Greeter Name*

First NameLast Name

Phone Number*

Area CodePhone Number

Ministry Resources

Could your ministry provide a 6 or 8 foot table(s) in the main flow of traffic to display Dr. Canion's ministry resources?*

If Dr. Canion's adjutants are not present, would your ministry appoint 2 people to be responsible for resources?*

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