|
*Name__________________________________________________________________________________ |
| *Please circle one: Church: Ministry: Men: Women: Children:
Drug: Non Profit Christian Organization: |
| *Address________________________________________________________________________________ |
| *City____________________________ |
*State______ |
*zip___________ |
*County_____________ |
| *Phone________________________ |
*Pastor/Director_________________________________________ |
| Information not printed: *required fields to be listed |
| *Contact Name_________________________________ |
Phone_________________________________ |
| *Delivery Address________________________________________________________________________ |
| *City____________________________ |
*State______ |
*Zip_______________ |
| *Number of households______. this will determine how many directories are given |
| *number of FREE directories requested:_____ |
| *Please breifly describe ministry: |
Please print and mail:
Divine Connections™ - free Listing Dept, P.O. box 492, Santa Maria, CA 93455 |
For Office Use Only |
Approved By:
Date |
Number of copies
dilevered |
Date Delivered |
Accepted By: |
| Download Free Listing Form |
