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Leader's Name *
Email and Phone*
Name of Sponsor Church or Organization *
Address 1 *
Address 2 *
City / State / ZIP *
Type of Event *
Website for Event *
Vision for the Event *
Expected Attendance at Event*
Start and End Date*
Speaker Requested *
Number of Times Speaking at Event *
Budgeted Honorarium (not including expenses) *
Are you able to cover all expenses including airfare, mileage, hotel, and meals for two people? *
Yes (two people)
Yes (one person only)
When do you need a formal commitment from R.A.G.E.? *
Share more info here as needed*
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