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<%if request.form("action") = "send" then Dim body Body = "Feedback form from website" & vbCRLF & vbCRLF Body = body & "First Name: " & Request.form("firstname") & vbCRLF Body = body & "Last Name: " & Request.form("lastname") & vbCRLF Body = body & "Address: " & Request.form("address") & vbCRLF Body = body & "City: " & Request.form("city") & vbCRLF Body = body & "State: " & Request.form("state") & vbCRLF Body = body & "Zip: " & Request.form("zip") & vbCRLF Body = body & "Phone: " & Request.form("phone") & vbCRLF Body = body & "TTY: " & Request.form("TTY") & vbCRLF Body = body & "Email: " & Request.form("Email") & vbCRLF Body = body & "I am: " & Request.form("Iam") & vbCRLF Body = body & "Comments: " & Request.form("comments") & vbCRLF & vbCRLF Body = body & "IP: " & Request.ServerVariables("REMOTE_ADDR") & vbCRLF If Request.form("Email") <> "" Then sendmessage "forms@silentblessings.org", Request.form("Email"), "Feedback Form", body Else sendmessage "forms@silentblessings.org", "webmaster@silentblessings.org", "Feedback Form", body End If if request.form("email") <> "" then autorespond request.form("email"), request.form("firstname") end if %>

Please include us in the Deaf Ministry Database



Name of Congregation:

Mailing Address:          

City:                               

State:                             

Zip:                                

Church Office Phone:    

E-Mail Address:            

Website Address:           

Denomination (if any):   

Pastor's Name:              

Deaf Ministry Leaders:

Approx. AM Attendance


Do any Deaf or Hard-of-Hearing people attend your worship services?      Yes        No

How many?                     



How do you help them participate in your worship services and other church activities?





Are there any small group fellowships for Deaf in your congregation? Yes        No

Briefly describe them.



Do any churches in your immediate area offer worship services, discipleship classes, or
fellowship activities for Deaf or Hard-of-Hearing people? Yes        No

Identify those churches.



Based on what you've learned about Silent Blessings and/or "Dr. Wonder's Workshop,"
what questions do you have for us?



Who else should receive this information and invitation to join our free national database?



Indicate if you would like more information about any of the following services we provide to congregations:
      Deaf Awareness Weekend
     Workshops for Deaf Ministry Leaders
     Networking with other Deaf ministries
     Consulting
     Books, CD's, DVD's, or other resources


Send materials for Hearing      Deaf       Both

Comments:



          

Note: The information you provide will be included in a searchable database of Deaf ministry resources by Silent Blessings Deaf Ministries and it's partners, Deaf Video Communications and Deaf Missions. Your information will not be sold to any marketing companies, nor will it be shared with other ministries or nonprofit organizations.

If you have any questions, or your information is not sent. . .
You can call our office manager, Judy, and talk directly to her.
Her toll-free number is:
877-367-3323

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Silent Blessings Deaf Ministries
1201 East 5th Street, Suite 11 • Anderson, IN 46012
Voice: 765-643-1040 • VP: 765-643-1040 • Toll Free: 877-FOR-DEAF
Email: friends@silentblessings.org

Copyright ©2003 Silent Blessings. All Rights Reserved