Reach Out

Name *

First Name

Last Name

Name *

First Name

Last Name

Do you have pastoral and board support for your request? *

Have your church board and pastor approved bringing the Nicodemus Society out to speak?

Yes

No

Still need to ask

Name *

First Name

Last Name

Pastor's Name *

First Name

Last Name

Proposed Start Date *

MM

DD

YYYY

Proposed End Date *

MM

DD

YYYY

Ability to Cover Costs *

What is the extent of your ability to cover costs (e.g. airfare, transportation, hotel, meals, incidentals, etc.)

All costs covered

No costs covered

Some costs covered (please explain in Other Comments)