Application for Scheduling

North Shore Baptist Associations

Evangelistic Block Party Trailer

NOTE: 2 checks payable to North Shore Baptist Associations must

accompany this application: 1)-$150.00 deposit & 2)-$150.00 Cost
Recovery fee
Your deposit check will be returned to you with the return of a cleaned trailer & the Block Party
Highlights form.

Date of Application       Requested Date of Usage      

Name of Church       Phone #      
Address       City       State LA Zip      
Pastor       Website      
Block Party Trailer is for Evangelistic Purposes ONLY. What type of
event will the Block Party Trailer be used for?      
Location/address where BPT will be set up:     
PERSON RESPONSIBLE FOR BLOCK PARTY TRAILER:
Name       Position      
Address       City       State LA Zip      
Phone #       Email address:      

We the undersigned have read and understand the guidelines and responsibilities for
use of the Evangelistic Block Party Trailer and make application for scheduling it with the
assurance that we assume responsibility for complying with these guidelines.
SIGNED
(Pastor) (Date)

SIGNED
(Person Responsible for BPT) (Date)

Make payable to: North Shore Baptist Associations and mail, fax, or email to North Shore Baptist
Associations
11411 McLaughlin Lane, Hammond, LA 70403, 225.567.5086 - bmo@i-55.com

For Office Use Only:

Deposit & CRF Received on _________ BPT Highlights Form Received _________
CRF Deposited on _________ Check # ________ Deposit Returned on _________