The Sanctuary Church of Indianapolis

SPEAKER REQUEST FORM

Please tell us about your ministry or organization

Name of Ministry/Organization

Pastor/Host Name

Ministry/Organization Website

Address 1

Address 2

Country

City

State

Zip/Postal Code

Phone Number

Email

Event Name

Is the event location the same as the ministry address?*
Yes
No

Which of the following are you asking Bishop Wilson to do?*
Preach
Teach/Lecture
Speak

Type of Event (Select One)

Event Date

Event Start Time

Is the event located outside of the state of Indiana?
Yes
No

Name of Primary Contact

First Name

Last Name

Primary Contact Email

Primary Phone Number