Request for Pastor Wesley to speak

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Date Event Begins

Date Event Ends

Is this event a . . .

Name of your Church or Ministry making request

What is your Pastor's name

Name of person making request

First Name

Last Name

Your Ministry Website Address

Church Address

Street Address

Other Address (optional

City

State

Zip/Postal Code

Region (optional)

What is your email address

What is your telephone number

Please be certain to include the area code

Attire for Service

Please include any additional information below.