Do you need a church?

The following form will be used for information we would need in order to provide follow-up care for you or a friend of yours. Please fill it out and submit it to JCFN and we will contact you after we receive it.

What is your name?("*"means required )

Last Name:	*
First Name:	*
Street Address :
City:
State/Prefecture:
Zip Code :
Country:
Phone:
Fax:
E-mail:	*
(1) Is this for you or for your friend?
Myself Friend
Last Name :
First Name :
Planned Moving Date: (month/date/year)
Date of Birth: (month/date/year)
Sex: Male Female
Marital Status: Single Married
Is it ok to be contacted by JCFN after moving?
Yes I would prefer initiating my own contact.
(2) Returnee's (or moving person's) Current Address
Street Address :
City:
State/Prefecture:
Zip Code :
Country:
Phone:
Fax:
E-mail:
Nearby Train Line :
Nearby Train Station :
(3) New Location
Street Address :
City:
State/Prefecture:
Zip Code :
Country:
Phone:
Fax:
E-mail:
Nearby Train Line :
Nearby Train Station :
(4) What kind of information would you or your friend like to receive?
Church to attend near by my house JCFN activities Campus ministries Christians who had been overseas, or fellowship of returning Christians Any nearby Christian fellowship or gathering held beside Sunday Missionary who lives nearby Nearby Christian book stores Bible Colleges or Seminaries in North America Bible Colleges or Seminaries in Japan Mission organizations Other:
(5) When and where did you or your friend accept Jesus Christ as your personal Lord and Savior?
When (month/year):
Where (State/Prefecture, Country):
If you are baptized, when and which church were you baptized in?
When (month/year):
Where (State/Prefecture, Country):
Name of the Church:
(6) Please feel free to write down any concerns or hopes regarding this upcoming move.

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