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:______________________

Contact Person:____________________________________________________________________________

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? _____________________________________________


Hotel Information:

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: ___________________________________________________________________________

Address: _________________________________________________________________________________

City: _____________________________________________________________________________________

Phone: ___________________________________________________________________________________

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: __________________________


Sound Engineering:

Bishop Larry Carnes prefers to use a lapel or an over the ear microphone.  Will either microphone be available?

Yes:________ No: ________


Product Sales:

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


________________________________                                    _____________________________________                  

Title                                                                                  Date 


Upon completion of this form, please sign and forward via email within three (3) business days:

                                   / 770 – 883 – 4477  (Admin.)