US GSM Contact Preference/Update Form

Please fill out this form to update your GSM Contact Information.

Non-US Samaritans Click Here!

Note: Please fill out the form for each Samaritan in your family. This helps us have specific details for each profile, (physical mail vs email) or what communicaiton list they want to be on, (prayer or newsletter.) If you have family members who share the same address as you and do not need to recieve their own communications, you do not need to fill out the form for them.

Name

*

Gender

*

Please select one option.

Male Female Other Prefer Not to Answer

Email

*

This address will receive a confirmation email

Mobile Phone

Home Phone

Address

*

Country

*

Please select all that apply.

USA

For the following date boxes, you can type in MM/DD/YYYY format or use the calendar.

Birthdate

Samaritan Since

Contact Options

*

Please select one option.

Physical Mail E-Mail Text All of the Above

Are you sure your contact preference above is correct?

*

Please select one option.

Yes

What would you like to receive (check all that apply)

Please select all that apply.

Newsletter General Communications Prayer List

Interested in Volunteering?

*

Please select one option.

Yes No

Any Notes / Comments / Feedback?

Description

Please fill out this form to update your GSM Contact Information.

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