Christian Party

Guestbook Registration and Membership Application

To join the Christian Coalition or to request more information about the Christian Coalition, please complete the form provided below.

Name:
Address:
City:
County:
State:
State or Province: (For International Guests)
Country: (For International Guests)
Zip Code:
Telephone:
Fax Number:
E-Mail Address:
Party Affiliation:

Voting Districts Numbers
(from your voter registration card):

Congressional:
State Senate:
State House:
Precinct Name:

Name of My Local Church:
My Church Denomination:

I am interested in:
joining the Christian Coalition
serving as a liaison from my local church for the Christian Coalition
becoming active in my local Christian Coalition chapter
attending the Road to Victory '99 conference in Washington, D.C. on October 1-2
receiving Action Alerts on legislative issues by:

Fax

E-Mail
receiving a Congressional Scorecard

I am interested in the following public policy issues: (mark as many as you wish)
Abortion/Euthanasia/Cloning
Campaign Finance
Child Care
Criminal Justice
Education
Elections
Gambling
Gay/Lesbian Issues
Health Care
Judicial Activism
Marriage/Family Issues
Pornography
Religious Freedom
Religious Persecution
Tax Policy

Christian Coalition Home Page

Modified Tuesday, November 02, 2010