AOT Ministry Request Local Form

Ministry Request Form (Local)

Please fill out this form completely. Incomplete information will delay processing. Form will not be submitted without required information. If item does not apply, please skip to the next item.
Who is this request for?*

Bishop Michael CanionDr. Tanda J. Canion
Church Information

Please provide information regarding your ministry
Name of Church*
Pastor's Name*
Church Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Church Phone*

Area CodePhone Number
Church Fax

Area CodePhone Number
Contact Information

Please provide contact information
Full Name*

PrefixFirst NameLast Name
E-mail*
Phone Number*

Area CodePhone Number
Alternate Contact Name

First NameLast Name
Alternate Contact Email
Alternate Contact Phone Number

Area CodePhone Number
The Service

Please provide details about the service
Please give the ministry dates (Include day(s) and time(s) for example Monday, April 12, 2011 at 7:00pm)*
Type of Service*
Theme
Location of Service*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Honorarium

*Please provide details about the speakers honorarium to avoid any miscommunication or division as stated in

I Corinthian 1:10
Is the honorarium percentage or set amount? (Additional Offering will not be raised if specific honorarium is established unless previously arranged.) Please specify Percentage or amount*
Would your ministry like for Bishop Canion/Dr. Canion to raise the offering?*

Yes (Please review previous information)NoUndecided
Enter the message as it's shown*
Should be Empty:

Church Information

Contact Information

The Service