Theology-on-Tap
Permission to Host Theology-on-Tap Form

Theology-on-Tap Permission to Host Form
Complete this form and return it to: Young Adult Ministry, Archdiocese of Chicago,
711 W. Monroe, Chicago, IL, 60661; Fax: 312-466-9474; or yam@yamchicago.org.

Name: ____________________________________________ Date: _______________

Title: __________________________________________________________________

Diocese: ________________________________________________________________

Parish / University / Organization: _________________________________________

Denomination: __________________________________________________________

Address: _______________________________________________________________

City, State, Zip Code: ____________________________________________________

Phone: __________________________ Fax: __________________________________

E-mail Address: _________________________________________________________

Website: _______________________________________________________________

How did you learn about the program?

________________________________________________________________________

Anticipated Hosting Dates: _____________________________________________________________________

Frequency (Weekly, Monthly, etc.): ________________________________________________________________

Setting (Parish, Restaurant, Bar, etc.): ______________________________________

_______ Yes, I have read, understand and agree to follow the Guidelines for hosting Theology-on-Tap.

___________________________________________
Signature