18 + Male/Female
Mr./ Mrs./ Ms./ *Mr.Mrs.Ms.
Name:
Phone. No.
E-Mail *
Your Sub Division
Zip
Church affiliation if any
Have you seen the Jesus DVD? Yes / No Language
Your comments / suggestion / decision.
Would you like to share this DVD with your neighbors? Yes / No / Will Consider If Yes,
which Street / Sub Division / Zip / Apartment you would like to distribute?
ZIP.
How many Jesus DVD and tracts and you need? 10 /20 /
Language
When do you think you can cover this area?
Do you have any prayer requests?
Pray / Participate / Finance support / Donate on line support. Would you like to take training for leadership in Missions? Yes / No / Consider
Sign
Date
