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
Name/Type of Service/Event
Service/Event Date & Time

MonthDayYear
Hour MinutesAM/PM Option
Allotted Time for Ministry
Please include the total amount of time allotted including message, altar call, etc.
Please list any additional flexible dates for consideration.
Venue Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Expected Attendance
Event Attire
Will there be any additional special guests in attendance?
If yes, please list any special guests that will be in attendance.
Honorarium
Please indicate the amount of honorarium planned.
Travel Reimbursement
Hotel Information
Please provide the name and address of your host hotel.
Is the sale of the speaker's products or merchandise permitted?
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