1. Personal Information

Your first name
Your last name
Street address
City
2-digit abbreviation for state
Zip code
Phone	#	()
Email address
Please indicate your permission to receive communications from World Vision by email		Yes No

2. Are you married?		Yes No
3. Do you have children?		Yes No

4. How did you find out about World Vision?		A Friend Newspaper Church Television Please indicate show below World Vision website School/University Event/Concert Please indicate which event below
5. Do you attend church regularly?		Yes No
If yes, please fill in church information below:
Church Name
City
2-digit abbreviation for state

6. What type of involvement would you prefer?

Financial Hands on/Volunteer Prayer

7. What region of the world are you interested in?

Africa Asia Europe Latin America Middle East North America Oceania

8. What countries have you visited?

9. Would you be interested in going on a Vision’s Trip to an area of your interest where World Vision has a project?

Yes No

10. How would you like to see your investment used? (please indicate all that apply)

Advocacy Children Christian Witness Clean Water Education/Skills Training Emergency Response Food Security Health Care HIV/AIDS Micro-enterprise development Youth

11. Would you like to receive information on a regular basis on the areas of interest selected above?		Yes No
If yes, how often?		Weekly Monthly Quarterly Annually

12. How would you prefer we contact you?

Email Mail Telephone Do Not Contact

13. Please indicate which of these you would like to receive.

Quarterly Magazine Annual Report Introduction of World Vision’s Work Around the World Vision

14. What do you most rely on for your information on current events daily or on a regular basis?

Newspaper Radio Television Internet

15. What type of music do you listen to most often?

Blues Christian Classical Country Jazz Rock Talk Radio

16. Where do you typically shop for greeting cards?

Christian Bookstore Hallmark Store Christian Bookstore Neighboring retail stores Grocery Store Shopping Mall Internet – Electronic Cards