Thank you for your interest in the Ministry of Dr. Jazz.

Please fill out the following questionnaire to assist you in scheduling Dr. Jazz for your next event. Please note: All inquiries will be responded to within 2 weeks.

Step 1 of 3

Booking
Name of Ministry / Host*
Ministry Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Senior Pastor*
Ministry Affiliation
Please enter Church/Host website
Contact Person / Event Coordinator*
Contact Email Address*
Contact Phone Number*
Fax Number

Event Information
Event Date*
MM slash DD slash YYYY
Event Time*

: Hours

Minutes

AM/PM
Event
Expected Number in Attendance
Event Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

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