BOOKING REQUEST FORM
Please complete this form to request Bishop Dillard for your event. This form is a request for information only and should not be considered a confirmation. Bishop Dillard believes in giving his best in each ministry moment and opportunity to share. He is honored by your invitation and will strive to bring tremendous impact and value to your ministry/organization. Upon receipt of all pertinent information, the administrative team will be in contact as soon as possible.
MINISTRY/ORGANIZATION INFORMATION
MINISTRY/ORGANIZATION NAME
*
Pastor/Host Name
*
First Name
Last Name
Ministry/Organization Website
*
Ministry/Organization Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Ministry/Organization Phone
*
-
Area Code
Phone Number
Ministry/Organization Email
*
example@example.com
EVENT INFORMATION
Event Name
*
Type of Event (Select One)
*
Convention/Conference
Luncheon/Banquet
Church Anniversary
Special Program (Legislature, Graduation, etc.)
Church Dedication
Convocation
Pastoral Anniversary
Pastoral Installation
Revival
Worship Service
Media Request
Other
Date of Event
*
-
Month
-
Day
Year
Date
Time of Event
*
1
2
3
4
5
6
7
8
9
10
11
12
:
Hour
00
10
20
30
40
50
Minutes
AM
PM
AM/PM Option
Event Site Location (If different from above)
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Additional Event Details (e.g., theme, multiple dates, event type, etc.)
Event Contact Person
*
First Name
Last Name
Event Contact Person Email Address
*
example@example.com
Event Contact Person Phone Number
*
-
Area Code
Phone Number
Submit
Should be Empty: