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Faith-Based-Practice-Study Application Form
*Name   
Address
City
State/Province
*Zip
Country
*Phone
*Email
*Do you set aside time daily in faith based practice?   YES    NO
 a. Approximately how long is the period of your practice?
 b. Briefly describe the basic nature of your practice.
 c. Do you practice more than once per day?
   2/day       3/day      4/day      more 
*Do you gather regularly with others in faith based practice?  YES  NO
If so, do you gather:    occasionally      weekly      daily  
 What is the name of your faith-based community; and, where do you gather?
 Is there is a leader? Who would that be?
*Would you and possibly members of your spiritual community be able to gather together in the evening of May 15th to hear more about the study?
  YES    NO