Coordinator's Name:

Coordinator's Email Address:

Name of Church:

Church Phone:

Church Address:

City:

St:

Zip:

Association:

Name of State Convention:

Pastor's Name:

Pastor's Email:

Approx Number of Member:

Approx Age of Church:

Date of Weekend:

Type of Weekend:

What other Renewal Weekends has church experienced:

Approx Year:

Coordinator Name if known:

Will church continue the Renewal Journey to the next weekend?

Number of visiting Adult Team Members

Number of visiting Youth Team Members

Number of visiting Children Team Members

Total Number on Visiting Team

Approximate Number of Adult Church Members Attending

Approximate Number of Youth Church Members Attending

Approximate Number of Children Church Members Attending

Approximate Total Number of Church Members Attending

Average number of small groups during the weekend

Salvation Decisions

Rededications

Other Commitments

Number or church members interested in serving as Team Members

Number of Small Groups Planned after Weekend (if known)

People Praying at the Alter on Saturday Night

Number Commissioned as Missionaries