Name *

First Name

Last Name

Check box below

Senior Pastor

Associate Pastor

Evangelist

Business Owner

Other

Who is the main contact person

First Name

Last Name

Phone

(###)

###

####

We are looking for cities where 8-12 churches will work together in unity to reach the lost. Can you commit to helping make this happen?

Yes

No

We try to be strategic about where we go so that we are not crossing states twice. Will you be flexible in coordinating an evangelistic outreach with us in your city?

Yes

No

Check the box below that best describes the unity in your city among the churches currently

Poor

Ok

Good

Excellent

Host Homes: If we are able to bring our Compassion to Action team, would host homes be available

Yes

No

Would you commit to financially helping sponsor a portion of this event?

Yes

No