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How did you hear about KMM?	(ex. book, conference, other leader/ministry)
Prior to the event, we will ship product to the address given below. This should be a physical address (not P.O. box) where UPS packages can be received.
Shipping Address Leave blank if same as above address

Contact Person Name
Title/Position	(ex: "Personal Assistant")
E-Mail Address
Phone Number	Type Cell Work Home
Phone Number 2	Type Cell Work Home

Below you may select up to 3 possible dates.


If a weekend is not available, would you consider mid-week? Yes

Notes about requested dates:

Event Description
Number of Congregations Involved	(enter "1" if hosting alone)
Expected Number of Attendees	(please be as specific as possible)
What is the capacity of the event facility?
Other Speakers	Yes   No Names:

Below, please give a brief description of your ministry