Quiet Place Ministries



Retreat Request Form
Please complete this form.


PERSONAL INFORMATION:

Today's date (mm/dd/yy):

Your email address:

Your name(s):

Your street address:

City:

State:

Zip code:

Telehone: (include area code)

Cell phone: (include area code)



MINISTRY INFORMATION:
Area of ministry:
Pastor   Youth Pastor   Associate Pastor
Missionary   Inner city ministry   Camp ministry
Other.  Please explain:

How many years have you been in ministry? 
Church or ministry name:

Telehone: (incl. area code)

Email address:

Website:


INCOME RANGE:
This information is completely confidential and optional.
$20,000 & under   $20,000 to $30,000
$30,000 to $40,000   $40,000 to $50,000   over $50,000

Does your church/ministry provide housing?  yes   no

Quiet Place Ministries serves those in vocational Christian ministry. Since the term Christian is often confused and twisted, we ask that you give us your salvation testimony. Please be specific in this area, as our program is geared to those who know Jesus Christ as their personal Savior. Please use as much space as you need. If both the husband and wife are taking part, please give the testimonies of each. Thank you so much.



Please list specifically why you are requesting a retreat. Please also let us know who the request is for, when you may be able to go, and how far (in hours) you are able to travel.



    
If the finances are available, and we believe that God has led us to sponsor a retreat for you,
we will contact you with more information. God bless you.

Directors: Brian & Theresa Hendrick
Office: 334 Bradley Drive, Jackson, Michigan 49201
Phone: 517-817-1680  E-mail: quietplaceministries@gmail.com

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Quiet Place Ministries in Jackson, MI