Booking Information

First Name: *

Last Name: *

Organization or Event Name (if applicable):

Your Title or Position with the Organization (if applicable):

Type of organization: * CorporatePrivate EventNPONGOOther CharityCommunity GroupChurch

E-Mail *

Contact Number: *

Who are you interested in booking: * Kurt Koch (Speaker)Kurt Koch (Concert)Kurtis Myson Band (Concert)

Event Location: *

Date of event: *

Start time of event: 8:00AM9:00AM10:00AM11:00AM12:00PM1:00PM2:00PM3:00PM4:00PM5:00PM6:00PM7:00PM8:00PM9:00PM10:00PM11:00PM12:00AM

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