Conference Form

Counsel from the Cross Ministries
Elyse Fitzpatrick

Conference Request Form

Scheduling a Conference with Elyse

If, after reading about scheduling a conference, you want to proceed, please complete the form below. It will be reviewed and you will hear back from us within one month. Please refer to Elyse's speaking schedule before requesting a specific date.

Applicant Information
First Name:
Last Name:
Address Street 1:
Address Street 2:
City:
Zip Code:	(5 digits)
State:
Sponsoring Church Information
Church Name:
Affiliation:
Contact Information
Daytime Phone:
Church Phone:
Email:
Previous Conference Information
Is this an annual conference?
How many were in attendance last year?
Specific Event Information Compliance
Travel and Boarding Requirements:
Dietary Restrictions:
How do you plan to advertise this event?
How did you hear about Elyse?
Please read and agree to the book sales policy.
Other Information
Choose your desired seminar topic and date:	(Only one topic, please)
	I have emailed a "Statement of Faith" to womenhelpingwomen@cox.net