Business Address:
P.O. Box 5763
Douglasville, GA 30154



Event Request Form

Name of Pastor/Ministry Head/Business Leader:
Church/Organization's Name:
Street Address:
Zip/Postal Code:
Business Phone:
Business Fax:
Website address:
Office Hours:
Contact Person:
Contact Cell:
Date of Event:
Time of Event:
Location of Event:
Type of Financial Remuneration to Speaker?:
**"If set amount, what is your speaker budget?:
What is the format?:
Will event be recorded?:
Theme or Purpose:
Handouts - can you make adequate copies?:
Is there a letter or brochure?:
If so, can you send us a copy?:
Are we allowed to sale resources?:
Is there a visible, high traffic area near an electrical outlet with one eight foot table for the sale of resources? :
Schedule of speaking time(s) for Elder Fishburne(please include time allocated):
Are there other speakers?:
If so, who are they and what are they doing?:
Who is expected to attend? - The demographics:
How many people are expected to attend?:

Facebook LinkedIn Twitter Blog Talk Radio YouTube