Date of the Event *

MM

DD

YYYY

Contact Name *

First Name

Last Name

Contact Phone *

(###)

###

####

Address of Venue *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Are you willing to pay for his expenses (Flight, Hotel, Food, etc) to come to your event? *

Yes

No

Is the sole purpose of this event to raise money for O.U.R. or The Nazarene Fund? *

Yes

No

Is this a paid speaking engagement? *

Yes

No