Speaking Engagement Request Form

Pastor's Name:

Church/Ministry Name:

Address:

City:

State:

Zip:

Office Hours:

Tel:

Fax:

Contact Person:

Tel:

Cel:

Email:

Theme and/or Purpose:

Location of Event (if different):

Date of Event:

Time of Event:

MINISTRY PRODUCTS

Bishop Bloomer will bring ministry products along during his visit. At least one 8-foot table is required for Bishop's sales team. For any information regarding ministry products, please contact the Sales Department at (919) 688-1565, extension 103.

Will Bishop Bloomer have a table to sell his product:

How many people are you expecting at the event:

**Please note that the above questions are to help the Sales Team determine how much product to ship for this event. So please give accurate
estimates to the best of your ability. In the past we've had churches give us extreme overestimates on attendance which resulted in Bishop
Bloomer overpaying for the shipment of product. Please do your best to help prevent this.

Speaking Engagement Request Form

MINISTRY PRODUCTS

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