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Pastors Member Survey

Please fill out the form below and click the submit button when you have completed the form. It will then be sent only to the church pastor. Note that some fields are marked * which means you need to complete that field with some information or just enter N/A where appropriate. Responses are not limited to one person per family.

Section One

Personal Information

Section Two

Home Visit Information

Section Three

Do you know of anyone that would also appreciate a pastoral visit? Please fill out each contact information below:

Section 4

Please answer all questions listed below. If you have no comment as to a question, please enter N/A into that field.