EmailMe Form - C3 Preliminary Application for Support

Name *

First Last

Current Address *

Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country / Region

Phone *

### - ### - ####

Email *

What is your affiliation with Carterville Christian Church? *

Member

Friend or relative of member

No affiliation

Other - please explain

Other Explanation

Organization Name *

Organization Contact Person *

First Last

Email *

Phone *

### - ### - ####

Organization Address *

Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country / Region

Organization Web Site *

Briefly describe the location, nature and timetable of your ministry and what your role will be: *

When will you begin, or is the work ongoing?

What level of partnership are you seeking? *

Financial support - on going

Financial support - one time

Other (please explain)

Other Explanation

Amount of financial request *

Additional Information