Your Name (required)

Your Email (required)

Name of Church

Denominational Affiliation (if any)

Address

City

State

Zip Code

Pastor's Name

Phone

Time of Regular Worship Service(s)

Interested in Concert?

 Yes No

If so, possible times

Interested in a Seminar for Worship Team?

 Yes No

Possible Dates?

Are you able to assist in covering Dr. Jutsum's basic travel expenses?

 Yes No

Any additional notes?

captcha
To make sure you are human, please enter the code shown above