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Interest Form
To find out more about the Center, please provide your contact and church information.
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First Name
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Your answer
Last Name
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Your answer
Email
*
Your answer
Mobile number (XXX-XXX-XXXX)
*
Your answer
Church Name
*
Your answer
Church Website
*
Your answer
Church Phone Number (XXX-XXX-XXXX)
Your answer
Church Address
*
Your answer
City
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State (XX)
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Your answer
Zipcode
*
Your answer
Country (USA/CANADA)
Your answer
Years in ministry
*
Your answer
Conference
*
Your answer
Actual Community Service Project (s)
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Interest
*
I would like to find out more about the Center for Community Change
I am interested in receiving mentoring in community engagement
I would like to talk to one of the mentors
I am looking for additional community service funding for my project
I am a Conference Administrator and would like to find out more about partnering with the Center
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