Full Name
*
First Name
Last Name
E-mail
*
Phone Number
*
-
Area Code
Phone Number
Ministry Area
*
example, Youth, Seniors, Groups
Program/Event Information
Name of Program/Event
*
Location of the Event
Date and Time of Event
-
Month
-
Day
Year
at
1
2
3
4
5
6
7
8
9
10
11
12
:
Hour
00
10
20
30
40
50
Minutes
AM
PM
AM/PM Option
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Fully Detailed Description of Program/Event
*
Is Childcare Provided?
Include ages and cost (if applicable).
Is registration / sign up required?
Yes
No
Registration Deadline & How To Sign Up
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(Note: Please export any Publisher Documents to a PDF)
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Notes or Additional Instructions
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