Leader's Name *

First Name

Last Name

Church or Organization Address *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Best Contact Phone *

Country

(###)

###

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Start Date of the Event *

MM

DD

YYYY

End Date of the Event *

MM

DD

YYYY

Address for the Event *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

When Do You Require a Final Commitment from Merritt Robinson Ministries? *

MM

DD

YYYY