Rutherford Ministry Request Form

Rutherford Ministry Request

Thank you for requesting Pastors Myles & DeLana Rutherford to attend your service. Please complete the following information as soon as possible to secure your ministry date.
Your Name*

First NameLast Name
E-mail*
example@example.com
Phone*

Area CodePhone Number
Church/Organization Name*
Pastor's Name (if different from person completing the form)

First NameLast Name
Please enter the website of your church or organization.*
Event Information

Please provide as much detail as possible about your service/event.
Requested Speaker*

Pastor Myles RutherfordPastor DeLana Rutherford
Name/Type of Service/Event*
Service/Event Date & Time*

MonthDayYear
Hour MinutesAM/PM Option
Please list any additional flexible dates for consideration.
Venue Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Expected Attendance

Less than 100100-300300-500500-10001000+
Event Attire
Will there be any additional special guests in attendance?*

YesNo
If yes, please list any special guests that will be in attendance.
Honorarium*
Please indicate the amount of honorarium planned.
Travel Reimbursement*

Travel reimbursement is in addition to honorarium and includes mileage over 50 miles from home church or flights for 2 people, and hotel accommodations. Check the box to acknowledge this agreement.
Hotel Information*
Please provide the name and address of your host hotel.
Is the sale of the speaker's products or merchandise permitted?*

YesNo
How did you hear about our ministry?*
Is there any additional information you would like us to know about your service/event?
Should be Empty:

Rutherford Ministry Request

Event Information