Wish Me A Merry Christmas - Community Impact Church Application

Please fill out the form below to apply to become a Community Impact Church.

*Pastor's Name
*Church Name
*Street Address
*Zip Code
*Pastor's Email Address
*Church Phone Number
*How did you hear about us?
*How many buttons are you considering ordering? (200 Minimum for the Community Impact Church designation)
Please enter a 1-2 sentence statement about why you feel the Wish Me A Merry Christmas Campaign is important. (This statement will be posted to our website and used in press releases to your local media.)
Please list any local media (newspaper(s), radio station(s), television station(s)) you would like us to contact with a press release about your involvement in the Campaign

*Required Fields