The Ohio Prayer Breakfast
Hyatt Regency Columbus
May 6, 2009, 7:30am
Keynote Speaker:
Tony Campolo
Name ___________________________

Company_________________________

Address__________________________

City_____________  State_________  Zip___________

Phone_____________________________
Ohio Prayer Breakfast

Seats @ $40/person: ________

Table of 10 @ $400: _________

Total Enclosed $____________

Please make all checks payable to:
Method of Payment: ___Check   ___Visa   ___Mastercard

Name on Card: _______________________________________________________________________

Credit Card #:___________________________________________  Exp. Date:_____________ 3 digit security code:_________

Signature:___________________________________________________________________________
PRINT THIS FORM THEN Mail with check or Fax with credit card info to:
The Gathering  |  3520 Snouffer Rd., Suite 200  |  Columbus, Ohio 43235  |  ph 614.336.3905  |  fax 614.336.3908


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