CHURCH PARTICIPATION REGISTRATION FORM (Individuals)

Church Name:
Pastor Name:
Sponsoring Church Organization:
Contact Name/Individual:
How did you hear about Us?:	YahooOther Search EngineTelevisionRadioFriend/FamilyPrint Media
Phone Number:
Fax Number:
Email Address:
Organization Address:	City: State:   ZIP:
Alternate Contact Person:
Alternate Contact Phone# :
Collection Goal:

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