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Speakers Clinic Form
Speakers Clinic Form
CCWC 2022 Speaker's Clinic
with Roy Hanschke
Application due no later than Aprilo 4.
Date:
mm/dd/yyyy format
Title:
First Name:
Mid Init:
Last Name:
Address:
City:
State:
Select
** -- **Blank**
AK -- Alaska
AL -- Alabama
AR -- Arkansas
AZ -- Arizona
CA -- California
CO -- Colorado
CT -- Connecticut
DC -- District of Columbia
DE -- Delaware
FL -- Florida
GA -- Georgia
GU -- Guam
HI -- Hawaii
IA -- Iowa
ID -- Idaho
IL -- Illinois
IN -- Indiana
KS -- Kansas
KY -- Kentucky
LA -- Louisiana
MA -- Massachusetts
MD -- Maryland
ME -- Maine
MI -- Michigan
MN -- Minnesota
MO -- Missouri
MS -- Mississippi
MT -- Montana
NC -- North Carolina
ND -- North Dakota
NE -- Nebraska
NH -- New Hampshire
NJ -- New Jersey
NM -- New Mexico
NV -- Nevada
NY -- New York
OH -- Ohio
OK -- Oklahoma
OR -- Oregon
PA -- Pennsylvania
PR -- Puerto Rico
RI -- Rhode Island
SC -- South Carolina
SD -- South Dakota
TN -- Tennessee
TX -- Texas
UT -- Utah
VA -- Virginia
VI -- Virgin Islands
VT -- Vermont
WA -- Washington
WI -- Wisconsin
WV -- West Virginia
WY -- Wyoming
Zip:
Day Phone:
Night Phone:
Cell Phone:
Email:
Website:
Blog:
Brief bio
:
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Number of talks given and size of audience (eg., my church, Bible conferences, 20 people, 200 people, etc.) :
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Share you speaking ministry hopes:
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What's the biggest improvement you hope to gain from this clinic?
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Verification Check:
Type the characters that you see in this picture.