Name*Email* Church/Organization*Address* Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Background*Number of Years at Current Church*Position*Denomination*Ordained?*Choose OneYesNoYear Ordained*Brief Description of Duties*Number of Sunday Worshippers*Number of Paid Staff Reporting to You*(Full Time & Part Time)Why do you need a rest?*Are you receptive to a phone call from Reverend Bruce Cote to discuss your situation?*Choose OneYesNoBest Time to Call* : Hours Minutes AM PM AM/PM Δ