Clergy Data Survey

If you have previously completed the "Clergy Gathering Registration" form, you do not need to complete this survey. Thank you!

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* 1. Please enter your contact information:

Name *

Church *

Address *

Address 2

City/Town *

State/Province *

ZIP/Postal Code *

Email Address *

Cell Phone Number *

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* 2. What is your gender?

Female

Male

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* 3. What is your birthdate?

Date / Time

Date

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* 4. Which of the following best describes your current relationship status?

Married

Widowed

Divorced

Separated

Single, never married

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* 5. Which of the following group(s) do you fall into?

White/Caucasian

Black, African American, African

American Indian or Alaskan/Arctic Native

Arabic/Middle Eastern

Asian

Hispanic or Latino/Latina/Latinx

Indigenous or Aboriginal Person

Native Hawaiian or Pacific Islander

Other (please specify)

Clergy Data Survey

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* 1. Please enter your contact information:

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* 2. What is your gender?

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* 3. What is your birthdate?

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* 4. Which of the following best describes your current relationship status?

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* 5. Which of the following group(s) do you fall into?

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* 6. What is your country of origin?