Edmonton Interfaith Centre For Education and Action Society

Thank you for registering for our Faith Representatives Resource list.

Please fill out the following information to help us know your qualified areas and interests.

PRINT this form off and MAIL IT to 11148 - 84 Avenue, Edmonton, AB   T6G 0V8.

PRINT Name ____________________________________________________________________________________

Address _____________________________________________________________ Postal Code __ __ __   __ __ __

Telephone (__________) _______ - ______________         Fax (__________) _______ - ______________

Email: ________________________________________ @ ___________________________________________________________

Faith/Religion (and denomination) _______________________________________________________________________________

Place of Devotion: ________________________________________ Cleric ___________________________________

Please MARK all the areas where we may refer or draw on you to SPEAK, PRESENT, or PROVIDE Information:

[_] Education/Workshops
 		 [_] Articles/Newsletter content
 
[_] Prayer Services
 		 [_] Press Interviews
 
[_] Spiritual Counselling
 		 [_] Faith History/Symbol
 
[_] Music/Arts/Performing
 		 [_] Youth Work
 
[_] Visits: Geriatric/Home/Hospitals
 		 [_] Event Planning/Committees
 
[_] Fundraising/Grant Writing
 		 [_] Advertising
 
[_] Traditions/Ceremonies/Sacred Dates  
 		 [_] Share Models/Best Practices
 
Other area(s) you would like to offer: ________________________________________________________________

Other general comments: ______________________________________________________________________

Thank you.

Your information may be made available to organizations requesting assistance with their interfaith efforts.
By providing your information, you are agreeing to such disclosure.