Larry Carnes Ministries Inc.
Ministry Request Agreement Form
Today’s Date: _______________
Host Church / Ministry Information:
Pastor/Head of Ministry: __________________________________________________________________
Church/Ministry Name: ___________________________________________________________________
Mailing Address: __________________________________________________________________________
City ______________________________________ State ________________________ Zip______________
Website Address: ____________________________________________________________________________
E-mail Address: ___________________________________________________________________________________
Church/Ministry Phone: ___________________________________________________________________
Church/Ministry Day’s of Operation __________ to _________ Hours of Operation ______ to________
Church/Ministry Seating Capacity:_________________
Length of Ministry Existence:______________________
Business Phone:_______________________________ Alternate Phone:_____________________________
(Please send a statement of beliefs and other information on Church/Ministry)
Event Information: (Please provide an Agenda for the event)
Date(s) of Event: ___________________________ Time of Event: _________________________________
Meeting Theme and Purpose:_______________________________________________________________
Location of Event (If different from the church):__________________________________________________
Will there be others speakers? Yes: ________ No:_________
If Yes, Who? _____________________________________________
Will you provide accommodations to include a Suite for Dr. Carnes and a room for his assistance?
Yes: ________ No:_________
Can only provide accommodations for Bishop Larry Carnes Yes:_________ No:_________
Name of Hotel: ___________________________________________________________________________
Confirmation Number (s):__________________________________________________________________
Will you be responsible for checking Bishop, Dr. Larry Carnes in and having his room key available upon his arrival? Yes: _________ No: _________
Dr. Carnes will be arriving via First / Business Class Accommodations (Premium Comfort is acceptable with prior approval from LCM). Delta Air Lines is Dr. Carnes airline of chose. Are you willing to pay for First or Business Class airfare? (Please check one) Yes _________ No _________
Name of Airport: __________________________________________________________________________
How far is the hotel from the nearest airport? _______________ miles or minutes (circle one)
How far is the hotel from the church? _________________________ miles or minutes (circle one)
Who will be responsible for meeting Bishop, Dr. Carnes at the airport?
Name: ______________________________________ Contact Number: __________________________
Bishop Larry Carnes prefers to use a lapel or an over the ear microphone. Will either microphone be available?
Yes:________ No: ________
Bishop Dr. Larry Carnes usually have products available for sale. Will you make space available for the sale of these products?
Yes: ________No: ________
Can you provide one (1) six (6) foot table to display products on? Yes: ________No: ________
If needed can you provide assistance to be available to assist in selling these items?
Yes:______ No:_______ Name(s) _____________________________________________________________
Day Number ________________________________ Evening Number: _____________________________
Products may be mailed prior to Dr. Larry Carnes arrival. Upon closing of the engagement will your representative assist in packing and mailing the remaining products back?
Yes: ________ No: ________
In addition to his honorarium, Bishop Dr. Larry Carnes reserves the right to receive a personal seed for his ministry. All checks should be made payable to Dr. Larry Carnes or Larry Carnes Ministries (LCM) as directed.
Signature Pastor / Head of Ministry
Upon completion of this form, please sign and forward via email within three (3) business days:
email@example.com / 770 – 883 – 4477 (Admin.)