Booking Form

BOOKING CONTACT FORM

If you have a confirmed booking with Chuck Girard, please complete the contact form below.
Fill in all mandatory fields (red asterisk), and as much of the rest of the form as possible. Thank You!
(FOR PROMO PICS AND CUSTOMIZED POSTER OPTIONS, CLICK ON POSTER SAMPLE)

* Indicates required field

Name of Church or Venue *

Date of Event *

Time of Event *

Address of Event *

Name of Pastor *

Church Website *

Name of person to be contacted by public for information *

First

Last

Public Phone Number *

Public Email *

All information below is for Chuck's eyes only

Name of Contact Person *

Contact Person Phone Number *

Contact's Email *

Emergency after hours phone (preferably cell#) *

Best address where Chuck can ship merchandise *

Line 1

Line 2

City

State

Zip Code

Country

Comment *

Submit