Treasure State Baptist Associati

Treasure State Baptist Association

BLOCK PARTY TRAILER APPLICATION 2008

Date of Application: ________________

Name of Church: ________________________________________________________

Pastor: ________________________________________________________________

Mailing Address: ________________________________________________________

City: ________________________________ State: ______ Zip: ________________

Requested Date of Use:

First Choice: From ________________ To ________________

Second Choice: From ________________ To ________________

Purpose of Use: _________________________________________________________

Name and Positions of Program Personalities::

Person Responsible for the Trailer:

Name ____________________________________ Position ___________________

Address ______________________________________________________________

City ________________________________ State ______ Zip _________________

Phone: Office __________________ Home _________________ Cell _____________

We, the undersigned, make application for scheduling the use of the trailer with the assurance that we assume responsibility for complying with the guidelines and for use of the trailer.

Pastor’s Signature _________________________________________ Date _________

Signature of Person Responsible for trailer _______________________ Date _________

Text Box: OFFICE USE ONLY
Date received: _____________
Fee Received _____________
Schedule & Guidelines sent __

A $75 fee MUST accompany this application. Make check payable to Treasure State Baptist Association.