COOCC Talk Show Guest Form
Please write the phonetic pronunciation of your full name
Your Ministry or Organization?
Street Address Line 2
State / Province
Postal / Zip Code
Do you have a Personal Website?
Why do you want to be on the COOCC Talk Show?
Topics you want to discuss
Please share any links to past speaking engagements
Please provide a high-resolution headshot to utilize in the Talk Show promotional materials
How did you hear about us?
Referred by someone
I'm a listener
Chaplains Office of Canada Website
Anything you want to add?
Please verify that you are human
Should be Empty:
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