| *First Name: | |
| *Last Name: | |
| Church/Organization: | |
| *Address | |
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| *City: | |
| *Zip Code: | (5 digits) |
| *State: | |
| *Country: | |
| *Daytime Phone: | |
| Evening Phone: | |
| Fax Number: | |
| Email: | |
When is the best time to contact you?
| Day Evening Either |
Have you hosted a meeting with Rev. Kenney in the past?
| Yes No |
Do you have specific dates in mind? If yes, please list dates.
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| What type of meeting would it be? | |
| What is the specific goal of the meeting? | |
| What role would Rev. Kenney play in the meeting? | |
Would the meeting be open to the public?
| Yes No |
| Where will the meeting be held? | |
| What is the attendance goal? | |
| How do you plan to promote the meeting? | |
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