Piercing Word Referral Form

When you give us information about a church or group, we will reach out and connect with them by phone and email. We'll tell them all about Piercing Word and invite them to our next public performance so they can see what we do for themselves. Please know that by referring an organization, there is no obligation on their part, we will simply introduce our ministry to them.

Tell us about you!

First Name *

Last Name *

Email *

Phone *

How do you know about Piercing Word? (Please check all that apply!)

I saw a performance!
I know someone on the team!
Internet search
Someone told me about Piercing Word

Who do you think should see us?

Church or Group Name *

Address (if known)

City *

State *

Who's the best person to contact about this group? (if known)

Contact Person's Phone # (if known)

Contact Person's Email (if known)

What type of group is this?

Church
Conference
College
Corporate Event
Women's Group
Men's Group
Youth Group
Children's Group
Christian School
Homeschool Group
Scouts/Awana/VBS
Camp
Retirement Home
Nursing Home
Homeless Shelter
Community Group
Prison Outreach
Other

Other...

Notes (tell us more about this group and why we should connect with them!)