Your Name *

First Name

Last Name

Demographic

Guest

New Member

Member

Distant Member

Elder

Date

MM

DD

YYYY

Interaction Type

Dinner out

Dinner at home

Home visit

Bible study

Message/Phone call (For Guest Only)

How was interaction received?

Great, going to meet up/meet again!

Good, positive response to message/call/visit

Hesitant, but interested.

Interaction not received well.

No response/Didn't Answer