Name of Parent Organization:___________________________________________ Date: __________

Address: _______________________________ City ____________________ Postal Code: ________

Name of Contact Person: _____________________________________________________________

Day Phone: _______________________________ Evening Phone: ___________________________

Email: _________________________________________________                                   Sex: _____     

Date you Propose to start the “You Can Still Pray in School” Campaign: ______________________

Address of the Meeting Place: _______________________________________________________

Phone at the Meeting Place: _____________________   Fax: ______________________________

Frequency of Meetings: ___ Monthly     ___ Bimonthly   ___ Other (Explain) _______________

____________________________________________________      _________________________


Proposed Director’s Name: _________________________________________________________


By signing below I affirm that this chapter of the “You Can Still Pray in School” Campaign will operate in accordance with the Concepts of Freedom Guidelines.

Signature: __________________________________________     Date:_____________________

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Concepts of Freedom Ministries