1.What is your first name?

2.What is your last name?

3.What is your email address?

4.What is your phone number?

5.What is the name of the church/faith-based organization you represent?

6.What is your role in your church/faith-based organization?

Pastor

Assistant Pastor

Elder

First Lady

Bishop

Apostle

Trustee

Deacon/Deaconess

Steward/Stewardess

Other (please specify)

7.What is your church's/faith-based organization's denomination?

Methodist

Baptist

Presbyterian

Church of God In Christ (COGIC)

Pentecostal

Non-denominational

Other (please specify)

8.In what zip code is your church/faith-based organization located?