National or Regional Association Name *

Association's Address *

Address Line 1

Address Line 2

City

State

Zip Code

Your Name *

First

Last

Your title/role *

Email *

Phone Number

How many congregations are in your regional association? *

How did you hear about us?

Another Regional Association
The internet
Our consultant
Our books (i.e. Fly in the Ointment, Penguins in the Pews, Owl Sight, etc.)
Other

The introduction you would like included in your assessment:

What roles would you like to be included in question #1 for respondents to pick from:

Examples: Regional Association Board or Committee Member, Active Clergy, Retired Clergy, Congregational Board (Vestry, Session, Council) Member, Regional Association Staff, etc.

Your supplemental questions (optional):

Your Logo that you would like included in the heading of your survey (optional):

Click or drag a file to this area to upload.

Splash page you would like folks to visit when they finish the assessment (optional):

Date you are wanting to launch the assessment:

Vista Option

Vista Assessment Only
Vista and Online Interpretation

We would also like our reports by (each option is $200 for reports please note sub reports by role are already provided):

Tenure
Age
Church size
Region (question must be added to supplemental questions)

We need the assessment in English and the following language (additional $200):

Spanish
Dinka
Korean

Is there anything else you would like us to know before we build your order?

Terms: *

I understand and accept the terms of this agreement for running the instrument. I understand that these instruments have been developed by and are the property of Holy Cow! Consulting. I understand that if I have ordered an onsite interpretation or any onsite consulting that travel and other expenses will be billed separately.