The Market Place Ministry is an exciting new ministry opportunity being initiated in partnership with The Needle’s Eye Ministries. This ministry is designed to equip us to take the Gospel into the work place where we spend most of our time during each week. In March of 2000, we will be having a seminar weekend dedicated to information and training of our parishioners as ministers in the market place. The first step in the process is to determine where we are during the week. This form is a type of census that will allow us to see where we are and begin to strategize how best to fulfill our call to take the Gospel into the world. We have duplicated this information form on both sides of the page, so that if there are two employed people in the family each can fill out a form. Thank you for your cooperation.

NAME__________________________________________AGE r18-24 r25-34 r35-49 r50-60 rOVER 60

(PLEASE PRINT)

r MALE r FEMALE

HOME ADDRESS_____________________________________ZIP__________PHONE_______________

CURRENT EMPLOYER___________________________________________________________________

BUILDING & STREET ADDRESS______________________________________________ZIP___________

WORK PHONE________________FAX_____________________E-MAIL___________________________

HOW LONG EMPLOYED____________________POSITION/TITLE_________________________________

IN 1 OR 2 SENTENCES, DESCRIBE YOUR ROLE/FUNCTION:

____________________________________________________________________________________

____________________________________________________________________________________

HOW LONG IN THIS POSITION?_______________PREVIOUS POSITION/TITLE_____________________

GENERAL AREA OF YOUR WORKPLACE: (CHECK ONE)	rDowntown rSouthside rInnsbrook rWest End rHanover rMechanicsville Proper
IF IN OFFICE PARKS / AREAS (SELECT ONE)	rMoorefield rKoger-South rInnsbrook rHanover Ind./Air Park rArboretum rKoger - West rDowntown West of 9th Street rDowntown East of 9th St. rBrookfield rOther__________________

DOES YOUR OFFICE/BUILDING HAVE A RESTAURANT OR CAFETERIA IN IT? r YES r NO

DOES YOUR OFFICE HAVE (ONE OR MORE) CONFERENCE ROOMS? r YES r NO

IS IT AVAILABLE TO EMPLOYEES BEFORE WORK, FOR LUNCH OR IMMEDIATELY AFTER WORK?

r YES r NO rNOT SURE

DOES YOUR OFFICE HAVE A MEETING/TRAINING ROOM? r YES r NO IF YES, WHAT IS

COMMENTS (IF ANY)

_______________________________________________________________________________________

_______________________________________________________________________________________