Michael Clark's Missionary Contact Form
Contact Information
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Section 1. Contact Information
First Name *
Last Name *
Name of event or how you found this sign up.  *
Date of event (or when you heard about it)
Organization you belong to (if applicable)
Email *
Phone *
Street Address (Number/Name)  *
City *
Province / State *
Postal Code / Zip Code *
Country *
Section 2. I will help Michael raise funds
I will help Michael raise money somehow:
Clear selection
I will personally donate to Michael's ministry:
Clear selection
I will organizationally donate to Michael's ministry:
Clear selection
I invite Michael to speak at our church or event:
Clear selection
I will sponsor Christian Candidates or Youth to enroll in the programs:
Clear selection
I will organize a fundraising party for Michael to speak at:
Clear selection
I will help with a peer-to-peer fundraising campaign to my network:
Clear selection
I will make some warm donors introductions for you:     
Clear selection
I am interested and would like to have a more in depth conversation:
Clear selection
Section 3. Donation Information
Charitable or Non-Charitable?
Clear selection
Monthly Donation Amount:
Monthly Donation Method:
One-time Donation Amount:
Donation Methods:
Credit Card number:
Credit Card Expiry:
Organization Name:
I will volunteer:
Clear selection
Receive emails from Michael:
Clear selection
I have some other referrals for Michael:
Clear selection
The David & Goliath Program - I may know a youth interested in attending
The David & Goliath Program - I will sponsor and pay for x amount of students - $2,000 per student
Section 4. Involvement
Are you currently involved in an organization?
Clear selection
Name of Organization and Role:
"I would consider becoming a Christian Candidate"     
Clear selection
"I would support a local Christian Candidate"     
Clear selection
Name of church you attend:
How did you hear about Michael's ministry?
Do you have an encouraging message for Michael?
Clear form
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