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To receive the promotion referenced on the card you received, and to be contacted by a Christian education consultant for your curriculum needs, please complete the following information (fields marked with * are required). Free product samples are only available for U.S. customers.

Personal Information:

Name:

Your Position/Title
at Church:

Street Address:

City:

State:

ZIP: *

Day Phone:

E-Mail:

Church Information:

Church Name:

Street Address:

City:

State:

ZIP: *

Church Phone:

Church E-mail:

Church Denomination:

Church website address:

Bible the church uses *

NIV

KJV

Other

Sunday School format the church uses:

Traditional
Large Group
Large Group/Small Group
Rotation Model
Other (specify)

Average
Sunday School attendance
(combine all classes)*

0-99	100-149
150-199	200-299
300-499	500+

What curriculum
do you use now?

Sample Information:

Please check the samples to send *

Preschool
Younger Elementary
Older Elementary

Are you considering
a change of curriculum?*

Yes No Unsure

When will you make your
next curriculum purchase?

(m/d/yy)

Please also send me information on:

Ministry Resources
VBS
Children's Church
Large group/small group curriculum
Rotation Model
Adult small group studies

Send the samples to the church address my home address

Email announcements*

	Please send information on promotions and new product announcements to my e-mail address
	Please DO NOT send information on promotions and new product announcements to my e-mail address

Please enter the Use Code found on your mailing piece: *
(Your Use Code can be found in the lower right hand
corner of the form you would normally mail in.)