Today's Date *

MM

DD

YYYY

Name *

First Name

Last Name

Are you an HNI Partner?

Yes

No

Address for the Church/Organization

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Do you have a preferred speaker? *

Please check only one box.

Barry Wissler

Steve Shank

Dave Hess

Desmond Frey

I don't have a preference

Are you willing to have another speaker come in you preferred speakers place if it does not suit?

Yes, get back to me with who you think would best suit!

No, I would like to stick with the one I've selected.