NOTE: The following information is what will be emailed to Pastor Tom. Where applicable use the to make your selection. If there are areas that you feel are unecessary simply type "na" into the text field provided.

1. Please specify whether you want to have the Pastor visit you at your home, make an appointment to meet with him in his office, make arrangements to meet publically somewhere, contact you by phone, contact you by email or visit via the internet.

2. Please let the Pastor know what time you would like to meet or what time he should call or visit.

If you selected "Other" above please specify below:

3. Please provide the Pastor with the following contact information
Your name:

Email address:

Phone number:

Directions: Please include any directions that you think might help the Pastor in identifying the location of your home, include such things as the literal address, landmarks, the color of your home or vehicles that would be parked on the street or in the driveway.

4. How would you like to have the Pastor confirm your visitation or contact request?

5. If there is a specific issue or concern that you think the Pastor should know about or something you think he might need to research prior to his visit or phone call please send him a brief message by typing it in the area below:

NOTE: If you do not feel comfortable submitting the above information over the internet please fill free to email Pastor Tom with your request. You can find his email address on the "Contact" page.