Encounter Participant Questionnaire
First Name
Last Name
Home Address
Phone Number
Email Address
Mobile Number
Please choose a provider
AllTel (USA)
Ameritech (USA)
AT&T (USA)
Beeline (Russia)
Bell Atlantic
Bell Mobility (Canada)
Bellsouth Mobility (USA)
BlueSkyFrog (Australia)
Boost Mobile (USA)
Bouygues Telecom (France)
BPL Mobile (India)
Cellcom
Centennial Wireless
Cincinnati Bell Wireless
Claro (Brazil)
Claro (Nicaragua)
Comcast PCS
Cricket
C-Spire (USA)
E-Plus (Germany)
Etisalat (Arab Emrates)
Fido (Canada)
Free Mobile (France)
Helio
Longlines (USA)
M1 (Singapore)
Manitoba Telecom Systems (MTS) (Canada)
Metro PCS (USA)
Mobistar (Belgium)
Mobitel (Sri Lanka)
Movistar (Spain)
MTN (South Africa)
Nex-Tech Wireless (USA)
Ntelos (USA)
o2 (Germany)
o2 (UK)
Optus (Australia)
Orange (India)
Orange (Netherlands)
Orange (France)
Orange (UK)
Powertel
Project Fi - Google
PSC Wireless
Qwest (USA)
Rogers Wireless (Canada)
Sasktel (Canada)
SFR (France)
SMS Global (Australia)
Southern LINC
Sprint PCS (USA)
StarHub (Singapore)
SunCom (USA)
T-Mobile (USA)
T-Mobile (Austria)
T-Mobile (Germany)
T-Mobile (Netherlands)
T-Mobile (UK)
Telefonica Movistar (Spain)
Telus Mobility (Canada)
Tracfone
US Cellular (USA)
Verizon
Virgin Mobile (USA)
Virgin Mobile (Canada)
Vodacom (South Africa)
Vodafone (Germany)
Vodafone (Italy)
Vodafone (Chuugoku)
Vodafone (Hokkaido)
Vodafone (Hokuriko)
Vodafone (Kansai)
Vodafone (Kanto)
Vodafone (Koushin)
Vodafone (Kyuushu)
Vodafone (Niigata)
Vodafone (Okinawa)
Vodafone (Osaka)
Vodafone (Shikoku)
Vodafone (Tokyo)
Vodafone (Touhoku)
Vodafone (Toukai)
Vodafone (Spain)
Vodafone (Italy)
Vodafone (UK)
Vodafone (New Zealand)
Age
Marital Status
Single
Engaged
Married
Partner
Widowed
Divorced
Separated
What prompted you participate in an encounter?
What do you expect to receive at the encounter?
Is this your first encounter?
Yes
No
Are you a member or regular attender of LWC?
Yes
No
Have you accepted Jesus Christ as your Lord and Savior?
Yes
No
Have you been filled with the Holy Spirit?
Yes
No
Have you ever been through Freedom Prayer or Sozo?
Yes
No
Are there any areas we can agree with you in prayer as you prepare for your encounter?
Please note here anything else you feel we need to be aware of as we prepare for your Encounter weekend, or anything you you would like to share with the Encounter leadership team.
Are there any limitations or special needs that you have?
Limited mobility, needing ground level access to facility
Vegetarian or special diet
Require bottom bunk bed
Use a C-pap machine & need to be near an outlet
Please specify special needs not mentioned above. (Also specify special dietary needs here.)
Do you snore?
Would you be willing to share a full or queen bed with another participate?
Yes
No
If so, with who?
Please note here any other questions, comments, concerns, etc. that you may have for the Encounter leadership team.
Submit