FAITH-BASED ASSOCIATES FORM

Church (FBO) Name *
Pastor (CEO) Name *

First

Last
Primary Contact *

First

Last
Primary Contact Title *
Email Address *
Website Address
Business Address *
City *
State *
ZIP Code *
Phone Number (for Primary Contact) *
Fax Number
Payment - Please check one: *

Now via Check* Invoice me for Full Amount Invoice me for Two Equal Monthly Payments Invoice me for Three Equal Monthly Payments *Please make checks payable to: Crime Stoppers of Michigan—Write ‘Project Good Samaritan’ on the memo line
Member Contact Information:

Include Name, Title, Mailing Address, and E-Mail
I would be interested in serving on a Faith-Based Program Focus Group *

Yes No
We would be interested in securing volunteers for Crime Stoppers events *

Yes No
We would be interested in securing volunteers for Community Response Team *

Yes No
We would be interested in being a host site for a Project Good Samaritan District *

Yes No
Please list ministries, outreach programs, trainings and/or certifications currently existing/operating in your congregation or FBO that could assist Project Good Samaritan in our work of serving families victimized by crime:

Crime Stoppers of Michigan is a 501(c)(3) organization. All contributions are tax deductible to the extent permitted by law.

CONTACT

Please take a moment to share any feedback, questions or concerns you may have!