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Name:
Church:
District:
Conference:
Address:
City:	State:	Zip Code:
Date of Birth (month / day/ year):

Chruch Position:	Lay Missioner Laity Clergy
Genre:	Masculine Femenine

Date (month / day/ year):

E-mail:

Telephone:

Fax:

Please identify the ministry or ministries you are working for:

What are the primary types or resources or services for your ministry or ministries for which you have a need?

How long have you been in your ministry work?

How long at this church?

Number of members in your church?

Average worship attendance of your congregation?