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* 1. Your Name

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* 2. Email

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* 3. Blog address? If no, just indicate no. Thanks.

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* 4. Twitter account? If so, indicate below

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* 5. What is it that makes you want to help others that have been affected by porn?

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* 6. Are you a committed follower of Christ? If so, please tell me about your relationship with God.

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* 7. Are you currently connected with a church? If so, please indicate what church and the name, position and email address of someone that works with your church(someone that knows you).

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* 8. Anything else you think I may need to know as someone who is being entrusted to lead others?

Thanks for the time, I will follow up with you within 24 hrs. - Chad

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