Unreached Nations, Inc.

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Basic Mission Questionnaire

Unreached Nations Inc.: 1605 Elizabeth Street, Pasadena, CA 91104 (626) 296-7699

Last Name*

First Name*

M. I.

Address

City

State/Province

Zip Code

Country

Date of Birth

Phone No

Email*

* required fields

1. You are:

Male

Female

2. Which of the following best describes you?

	High School student		Mission Pastor
	College (undergraduate) student		Church mission board member
	Working adult/church lay leader		Youth pastor
	Senior pastor		Member of youth group
	Church staff member		Church member
	Graduate student		Others

3. Describe your interest(s) in missions

	Full-time/career		Overseas missions
	Short-term		Prayer support of missions
	Domestic missions		Financial support of missions

4. Information requested is for:

	Immediate use		Reference use/plan career
	Use within 12 months		Others

5. Church denomination:

6. The Church you attend: (indicate all that apply)

	Has an active missions program		Supports agency missionaries
	Has an annual mission conference		Plan to start a missions program
	Supports denominational missionaries		None of the above

7. What Nations (ethnic groups) "reached" or "unreached" are you interested in?

Information and Help desired - please explain below:

Optional:
Describe any mission experience you have had: