Please complete the following form to request Dr. Cosby to preach or speak at your upcoming event.
HOST INFORMATION:
Name of Person Extending Invitation:
*
Name of Church or Sponsoring Organization:
*
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Church or Organization’s Main Phone Number:
*
Please enter a valid phone number.
Church or Organization’s Website:
*
CONTACT INFORMATION
Name of person responsible for administrative and logistical details re. engagement:
*
Cell:
*
Please enter a valid phone number.
Office:
*
Please enter a valid phone number.
Email:
*
example@example.com
Day of Event Contact Name:
*
Day of Event Contact Cell:
*
Please enter a valid phone number.
EVENT INFORMATION
Type of Event: (check boxes)
*
Worship Service
Revival
Banquet/Gala
Conference/Seminar
Panel Discussion
Other
Event Date:
*
-
Month
-
Day
Year
Date
Event Start Time:
*
Hour Minutes
AM
PM
AM/PM Option
Event Name:
*
Theme:
Scripture Reference:
Additional Information Pertinent to Event:
Name of Event Location (if different from above):
Name
Address of Event Location (if different from above):
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
TRAVEL
If air travel is required, please provide closest and secondary airport code(s).
Option 1 (closest):
Option 2 (secondary):
Typical travel time from airport to hotel:
Typical travel time from hotel to event location:
Please verify that you are human
*
Submit
Should be Empty: