1.	Do you wish to receive a FREE subscription to Worship Facilities?

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First Name:
Last Name:
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Company Name:
	(Please provide your Company Name in full: abbreviations could disqualify you)
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What is the approximate number of employees in your company? (select only one)

Select Number of Employees Less than 50 50-99 100-499 500-999 1,000-4,999 5,000-9,999 Greater than 10,000

Yes, please auto-fill my contact information for other publication qualification forms.

2.	What is the nature of your business? (select only one)

Church (church staff or volunteer)	Service Provider
Architect	Other (Please specify)
Builder

3.	What is your church's denomination? (select only one)

Baptist	Presbyterian
Pentecostal	Independent/Non-Denominational
Methodist	Other (please specify)
Lutheran

4.	What is the approximate square footage of your entire facility? (select only one)

< 20,000	50,000-99,999
20,000-49,999	> 100,000

5.	Please indicate your level of purchasing authority: (select only one)

Authorize	Influence/Recommend
Specify	None

6.	Your primary job function: (select only one)

Pastor	Business Administrator
Executive Pastor	Building Committee Member
Facilities Manager	Other church decision maker
Operations Manager

7.	Do you include audio/video production in your worship service?

Yes     No

8.	Is your church planning a building/remodeling project?

Yes     No

9.	Which of the following is part of your worship facility? (select all that apply)

Daycare	Kitchen & Cafeteria
Elementary/Secondary School	Multi-purpose Room
Indoor Sports Facility	Retail Space
Outdoor Sports Facility	Off-site parking

10.	We require a unique identifying piece of information in order to verify this request is valid: On what day of the month were you born?

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11.	May we contact you via email regarding your subscription?

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12.	May we contact you via email regarding Worship Facilities products and events?

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13.	May we contact you via email regarding products or services from selected companies that Worship Facilities thinks may be of interest to you?

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