Changed Life Ministries

Changed Life Ministries
Mailing address: 3667 Greyhawk Court, Concord, CA 94518

> Ministry Booking Request
> Genesis Fund
> Ministry Press Kit


Subject Field:
* Full Name:
*E-mail Address:
*Phone Number:
Address:
City:
State/Prov:
Zip:
Country:
Comments:

Ministry Booking Request

INFORMATION PROFILE

Church/Organization Name:

Church Affiliation or Denomination:

*Contact Person:

*E-mail Address:

*Phone Number:

Fax Number:

Address:

City:

State/Prov:

Zip:

Country:

Time Zone:

Eastern	Mountain	Central
Pacific	Other

How Did You Hear About Scott Brooks?

EVENT DETAILS

*Date Of Event:

*Event Location:

*Theme:

Event Details:

How Many Are You Expecting In Attendance?

What Are The Names Of Any Other Guests/Speakers That Will Be Ministering At The Event?

*Is The Event For ..

Youth Adults Youth & Adults

*What Date(s) And Time(s) Will You Need Scott Brooks To Speak?

*What Is The Speaker's Honorarium For This Event?

*Does The Church/Organization Agree To Cover The Travel Expenses For Scott Brooks And One Assistant?

Yes No

Ministry Press Kit

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Press “Save” to complete the download

> SCOTT BROOKS BIO

> IRS TAX FORM W-9

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INFORMATION PROFILE

First Name:

Middle Initial:

Last Name:

Street Address:

Mailing Address:

City:

State:

Zip Code:

Home Phone:

Cell Phone:

Email:

Marital Status:

Married	Single	Engaged
Divoreced	Widowed

Number Of Children:

Names And Ages Of Children:

Are You Presently Employed?:

Yes
No

Name Of Employer:

Employers Address:

Name Of Supervisor:

Supervisors Phone Number:

Occupation:

Years At This Job:

Previous Employmnet:
(Name, Position, Years at Job)

Current Salary:

Last Years Total Annual Income:

What Are You Applying For:

Used Car Donation

Home Applicant

Other

Family Referral # 1
This referral should be a close family member who is aware of your situation.

Name:

Address:

Home Phone:

Cell Phone:

Relationship To You?

Referral # 2
Please list someone other than a family member or relative as this referral.

Name:

Address:

Home Phone:

Cell Phone:

Years Known:

Relationship To You?

Your Story
Please let us know as much as you are willing to reveal about your situation and specifically how assistance from the Genesis Fund would benefit you and your family.