Wufoo

Your Name (or Group Leader's Name) * First Last
Your Address *
Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country
Your Email *
Your Phone Number * ### - ### - ####
Your Church's Name
Your Church's Address
Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country
Your Church's Phone Number ### - ### - ####
Your Church's Website
Approximate number of church members
Pastor's Name First Last
Our church currently has an outreach to:
Those with disabilities Those with chronic illness
Does this person who is leading the HopeKeepers group have a chronic illness?
Yes No
If no, who will be co-leading the group who does have a chronic condition?
Date you expect your group to start -- or the date it began. * MM / DD / YYYY
What do you see are the current needs of your church in regard to chronic illness/pain ministry and outreach? *
I have read and understand the following and by checking these boxes I agree that I will have done so. Statement of Faith and Viewpoint on Healing and HopeKeepers Logo Useage Agreement *
Rest Ministries Statement of Faith Rest Ministries Viewpoint on Healing
Thank you! As a registered HopeKeeper group you will receive information on new resources and additional church outreach materials when they are available. Please let us know if your group discontinues so we can keep our listing updated.

Any other questions or comments?
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