SHECHEM MINISTRIES

                               A REFUGE FOR PREACHERS

                                          

                             APPLICATION*

IN A CRISIS, APPLICATION CAN BE COMPLETED ON THE PHONE.  CALL JIM TERRY @ 502-680-6875 OR GENE KOONS AT 502-839-6116.

DATE______________

Name _________________________ Wife’s Name _________________

Total number of people that will be at Shechem?  ____________________

Home Address______________________________________________

                         ______________________________________________

Home Phone __________________Cell Phone ____________________ 

E- Mail Address __________ ______________

Date desiring to come____/____/____.

Time you will arrive _________(Eastern Standard Time)

Date you plan to depart ____/____/____.

Time you will depart____________(Eastern Standard Time)

Reason for visit:  Crisis __ Time off___

Church  __________________________

Address ___________________________

              ___________________________

Church Phone #  ________________________

Have you been to Shechem before? ____     When? ___________________

If you find you are going to be late arriving, please call:

Gene Koons (Church) 502-839-6116 or,

Jim Terry Home # 502-839-3839 or Cell # 502-680-6875.

  

Please, have a good time, and God bless you!

*TO SUBMIT THIS APPLICATION, COPY AND PASTE BLANK APPLICATION TO:  E-MAIL, complete and send e-mail.

All first time applications may be reviewed by a committee at MT Eden Christian Church. No information about your stay will leave this committee.

MT Eden Christian Church

Attn. Shechem Ministries

12241 MT Eden Road

MT Eden, KY 40046