Thank you for reqesting to host a CJA event !  All fields are required. If you don't have an answer, please enter "None". And of course, be honest!

First Name

Last Name


Type of CJA event you would like to host?

Coffee with CJA

Pizza withCJA

Burgers with CJA

Ice Cream with CJA

Cookout at your home

Other Type of Event:

Other Event Type

Location of event?

Event Location? 

What is the closest city near you?


Do you belong to any Jeep or off-road clubs? If so, which clubs?


Your Jeep: Year, Model & 2 or 4 Doors


What do you love about your Jeep or Jeepin?

Do you consder your Jeep a...

Rock Crawler


Mall Crawler

Daily Driver 

None of the above

Name of the church (& city) you worship at on Sundays.


Favorite Bible Verse

What is the Great Commission all about?  (No Googling)

Finish this verse " To the ends of the___________." (No Googling)


Ministry Experience and/or Ministry Training

Your Email

Phone Number

  Is this your cell phone?   Yes


Address Line #2







Why do you want host a CJA event

When you submit this from you will see "Thank You". If you don't see "Thank you", scroll up and provide the missing information.   Please allow one week to review your request.