National Week of Prayer For the Healing Of AIDS

To enter your congreation as a participant in the National Week of Prayer for the Healing of AIDS National Map please complete the form. Our staff will update the map with your information.

Congregation Name *
Street Address (No PO Boxs Accepted) *
City *
State *
Zip *
Phone Number *
Congregation Leader *
Leader Title *
E-mail Address: *
Contact Person
Contact Person Email
How many members does your church have? (Please check the appropriate box.) *	Under 100 101 - 500 501 - 1000 1001 - 5000 5001 - 10000 10,000+
How would you describe the racial/ethnic composition of your congregation? We are predominately... *	Black/African American Hispanic White/Anglo Native American/American Indian Asian/Pacific Islander Multicultural (no single group represents more than half the total congregation)
Please indicate which type of ministry your church has: *	HIV/AIDS Ministry Health Ministry Both None of the above
What types of events do you plan to implement as part of the National Week of Prayer for the Healing of AIDS? (Please check all that apply.) *	Special sermon that relates to NWPHA and its mission Special Worship Service Distribute NWPHA and HIV/AIDS materials to congregations and/or community members Partner with a local health department, AIDS organization or other community-based organizations to implement a NWPHA event Hold a special concert at the church aunch an HIV/AIDS testing campaign Do not know / Not sure Other (Please specify in space provided)
If you selected Other above please use this space to specify your activity:
What is the title of your Program?
What is the date of your Program?
What is the time of your Program?
What is the location for your Program?
If you have not determined the location for your Program check here.	Do not know / Not sure
Is this your first time participating in the National Week of Prayer for the Healing of AIDS? *	Yes No
Are you planning to take steps towards gaining media attention to your campaign? *	Yes No
Will you need technical assistance from The Balm In Gilead, Inc. to implement your campaign? *	Yes No Do not know / Not Sure


* Required