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Name of Organization

Authorized contact person (and title)

Full Mailing address

Phone
Fax
E-Mail
Web Site

Desired program date:
Secondary date:

Presentation setting:

classroom
auditorium
sanctuary

Type of presentation desired:

Antticipated audience:
20 - 50
51 - 100
101 - 250
251 - 500
501 or greater

Average age

college students
men

women
Other:

Airport to fly into:

Distance from airport to event:
miles

How did you learn about ProdigalSong Ministries?

Any additional details:


 


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