We want to know YOU! Because you are our neighbors, we want to know how we can serve you! Question Title * 1. What is your biggest source of stress these days? Question Title * 2. If you could change one thing in your life, what would it be? Question Title * 3. In what areas would you like to improve your health? Exercise Nutrition Sleep Beverages Smoking Stress Management Other (please specify) Question Title * 4. Which of the following programs would you be interested in attending if they were held within one mile of your house? Healthy Cooking Class Stress Management Class Money Management Class Financial Management Class Weight Loss Class Stop Smoking Class Greif Support Group Depression Recovery Group Personal Bible Study Social Activities Vacation Bible School Question Title * 5. How can we pray for you? Question Title * 6. If you would like for someone to contact you about other needs you may have, please enter your contact information below. Name Address Address 2 City/Town State/Province ZIP/Postal Code Country Email Address Phone Number Done