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Michael Clark's Missionary Contact Form
Contact Information
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Section 1. Contact Information
First Name
*
Your answer
Last Name
*
Your answer
Name of event or how you found this sign up.
*
Your answer
Date of event (or when you heard about it)
MM
/
DD
/
YYYY
Organization you belong to (if applicable)
Your answer
Email
*
Your answer
Phone
*
Your answer
Street Address (Number/Name)
*
Your answer
City
*
Your answer
Province / State
*
Your answer
Postal Code / Zip Code
*
Your answer
Country
*
Your answer
Section 2. I will help Michael raise funds
I will help Michael raise money somehow:
Yes
No
Maybe (discussions required)
Clear selection
I will personally donate to Michael's ministry:
Yes
No
Maybe (discussions required)
Clear selection
I will organizationally donate to Michael's ministry:
Yes
No
Maybe (discussions required)
Clear selection
I invite Michael to speak at our church or event:
Yes
No
Maybe ( discussions required)
Clear selection
I will sponsor Christian Candidates or Youth to enroll in the programs:
Yes
No
Maybe (discussion required)
Clear selection
I will organize a fundraising party for Michael to speak at:
Yes
No
Maybe (discussion required)
Clear selection
I will help with a peer-to-peer fundraising campaign to my network:
Yes
No
Maybe (discussion required)
Clear selection
I will make some warm donors introductions for you:
Yes
No
Maybe (discussion required)
Clear selection
I am interested and would like to have a more in depth conversation:
Yes
No
Maybe (discussion required)
Clear selection
Section 3. Donation Information
Charitable or Non-Charitable?
Charitable Donation (get receipt)
NON Charitable Donation
Clear selection
Monthly Donation Amount:
Your answer
Monthly Donation Method:
auto withdrawal from bank
Credit Card
Other
One-time Donation Amount:
Your answer
Donation Methods:
E-Transfer to: Michael@MichaelRJClark.com
Credit Card
Cheque
Other
Credit Card number:
Your answer
Credit Card Expiry:
Your answer
From:
Individual donation
Organizational donation
Organization Name:
Your answer
Other
I will volunteer:
Yes
No
Maybe
Clear selection
Receive emails from Michael:
Yes
No
Clear selection
I have some other referrals for Michael:
Yes
No
Maybe
Clear selection
The David & Goliath Program - I may know a youth interested in attending
Your answer
The David & Goliath Program - I will sponsor and pay for x amount of students - $2,000 per student
Your answer
Section 4. Involvement
Are you currently involved in an organization?
Yes
No
Clear selection
Name of Organization and Role:
Your answer
"I would consider becoming a Christian Candidate"
Yes
No
Clear selection
"I would support a local Christian Candidate"
Yes
No
Clear selection
Name of church you attend:
Your answer
How did you hear about Michael's ministry?
Your answer
Do you have an encouraging message for Michael?
Your answer
Notes:
Your answer
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