Northminster Presbyterian Church Visitors Survey

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1. This question requires an answer.

This question requires an answer.   Name:
Address:
Address 2:
City/Town:
State:	-- select state --AL AlabamaAK AlaskaAS American SamoaAZ ArizonaAR ArkansasCA CaliforniaCO ColoradoCT ConnecticutDE DelawareDC District of ColumbiaFM Federated States of MicronesiaFL FloridaGA GeorgiaGU GuamHI HawaiiID IdahoIL IllinoisIN IndianaIA IowaKS KansasKY KentuckyLA LouisianaME MaineMH Marshall IslandsMD MarylandMA MassachusettsMI MichiganMN MinnesotaMS MississippiMO MissouriMT MontanaNE NebraskaNV NevadaNH New HampshireNJ New JerseyNM New MexicoNY New YorkNC North CarolinaND North DakotaMP Northern Mariana IslandsOH OhioOK OklahomaOR OregonPW PalauPA PennsylvaniaPR Puerto RicoRI Rhode IslandSC South CarolinaSD South DakotaTN TennesseeTX TexasUT UtahVT VermontVI Virgin IslandsVA VirginiaWA WashingtonWV West VirginiaWI WisconsinWY Wyoming
ZIP/Postal Code:
Country:
Email Address:
Phone Number:

2. Employer

Employer

3. Type of work you do

Type of work you do

4. How did you hear about Northminster Presbyterian Church and what attracted you to visit?

How did you hear about Northminster Presbyterian Church and what attracted you to visit?

5. Age Group

Age Group   18 to 30 31 to 40 41 to 50 51 to 60

61 to 70 71 to 80 81 to 90 90 to +

6. Your Household: Children at home (Please note number in each group in the space provided)

Your Household: Children at home (Please note number in each group in the space provided)   Age 0+ to 3 Yrs
Age 4 to 7 Yrs
Age 8 to 11 Yrs
Age 12 to 15 Yrs
Age 16 to 19 Yrs

7. Please indicated any area that might be of interest to you or about which you would like more information:

Please indicated any area that might be of interest to you or about which you would like more information:   Adult Choir Adult Education Adult Fellowship Children's Choirs Children's Ministries Church Library Church School

Committees and Teams Handbell Choirs Health Ministry Men's Ministries Middle School Youth Group Mission Activities Parents with a Passion

Preschool & Mother's Day Out Senior High Youth Group Small Groups Sound and Spirit Concerts Stephen Ministry Vacation Bible School Women's Ministries

8. Are there any cares or concerns for which you would like us to pray?

Are there any cares or concerns for which you would like us to pray?

9. Do you have any questions or thoughts for the ministers?

Do you have any questions or thoughts for the ministers?

10. May we add you to the e-mail list for upcoming events and activities at Northminster?

May we add you to the e-mail list for upcoming events and activities at Northminster?