Book Ben Cerullo for your event

Booking Request Form

First Name:
Last Name:
Ministry or Church:
Title:
Address:
City:
State:
Zip:
Country:
Web Address:
Phone:
Email:
Fax:
How did you find us?
--------------------------------------------------------
Please send me the following materials:
Speaker Fees Promo DVD Biographical Information
--------------------------------------------------------
Please describe the event's format:
Church: Crusade: Evangelistic Outreach: Festival:
--------------------------------------------------------
What is the theme of your event and describe the issues related to your event that the speaker will need to address?

--------------------------------------------------------
Event Name:
Event Dates:
Event Location:
Event Budget:
Approx. # of Attendees::
--------------------------------------------------------
Venue Capabilities:
Audio: Video: Venue Occupancy:
--------------------------------------------------------
Do you need an Interpreter? (check for yes)
--------------------------------------------------------
	Please verify the characters in the image below.