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Your Name *

First Name

Last Name

Your Best Mobile Phone Number *

(###)

###

####

Is it okay to correspond via text message to the mobile number listed above. *

YES

NO

Church or Organization Name *

First Name

Last Name

Requested Event Date *

MM

DD

YYYY

Does a 7:00 PM event time work for your church? *

YES

NO

Address of Event Location *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country