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* 1. Name

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* 2. Email address:

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* 3. City of residence:

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* 4. Church or organizational affiliation:

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* 5. How did you hear about Telos and become interested in our trips?

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* 6. Are you interested in a Telos trip for just you, or also for other members of your community?

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* 7. If you are interested in a Telos trip for just you, or you and a spouse/friend... Most, but not all, Telos trips serve a specific community or organization. Would you be interested in being included in one of these trips?

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* 8. If you are interested in a Telos trip for a larger party, how many people from your community do you think would be interested?

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* 9. If you have any specific windows of availability for participating in a Telos trip, please list them below:

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* 10. Are you interested in receiving our excellent weekly newsletter to stay up to date on Israel-Palestine and peacemaking related news stories and resources?

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* 11. Any additional comments or questions?

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