Personal Information

12Gender:	--MaleFemale
13His First Name:
14His Last Name:
15Her First Name:
16Her Last Name:
20Street Address:
22City:
23State:	--AlabamaAlaskaAlbertaAmerican SamoaArizonaArkansasArmed Forces AfricaArmed Forces AmericasArmed Forces CanadaArmed Forces EuropeArmed Forces Middle EastArmed Forces PacificBritish ColumbiaCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineManitobaMarshall IslandsMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew BrunswickNew HampshireNew JerseyNew MexicoNew YorkNewfoundlandNorth CarolinaNorth DakotaNorthern Mariana IslandsNorthwest TerritoriesNova ScotiaNunavutOhio ( Select County )Ohio (Adams County)Ohio (Allen County)Ohio (Ashland County)Ohio (Ashtabula County)Ohio (Athens County)Ohio (Auglaize County)Ohio (Belmont County)Ohio (Brown County)Ohio (Butler County)Ohio (Carroll County)Ohio (Champaign County)Ohio (Clark County)Ohio (Clermont County)Ohio (Clinton County)Ohio (Columbiana County)Ohio (Coshocton County)Ohio (Crawford County)Ohio (Cuyahoga County)Ohio (Darke County)Ohio (Defiance County)Ohio (Delaware (COTA) County)Ohio (Delaware County)Ohio (Erie County)Ohio (Fairfield (COTA) County)Ohio (Fairfield County)Ohio (Fayette County)Ohio (Franklin County)Ohio (Fulton County)Ohio (Gallia County)Ohio (Geauga County)Ohio (Greene County)Ohio (Guernsey County)Ohio (Hamilton County)Ohio (Hancock County)Ohio (Hardin County)Ohio (Harrison County)Ohio (Henry County)Ohio (Highland County)Ohio (Hocking County)Ohio (Holmes County)Ohio (Huron County)Ohio (Jackson County)Ohio (Jefferson County)Ohio (Knox County)Ohio (Lake County)Ohio (Lawrence County)Ohio (Licking (COTA) County)Ohio (Licking County)Ohio (Logan County)Ohio (Lorain County)Ohio (Lucas County)Ohio (Madison County)Ohio (Mahoning County)Ohio (Marion County)Ohio (Medina County)Ohio (Meigs County)Ohio (Mercer County)Ohio (Miami County)Ohio (Monroe County)Ohio (Montgomery County)Ohio (Morgan County)Ohio (Morrow County)Ohio (Muskingum County)Ohio (Noble County)Ohio (Ottawa County)Ohio (Paulding County)Ohio (Perry County)Ohio (Pickaway County)Ohio (Pike County)Ohio (Portage County)Ohio (Preble County)Ohio (Putnam County)Ohio (Richland County)Ohio (Ross County)Ohio (Sandusky County)Ohio (Scioto County)Ohio (Seneca County)Ohio (Shelby County)Ohio (Stark County)Ohio (Summit County)Ohio (Trumbull County)Ohio (Tuscarawas County)Ohio (Union County)Ohio (Van Wert County)Ohio (Vinton County)Ohio (Warren County)Ohio (Washington County)Ohio (Wayne County)Ohio (Williams County)Ohio (Wood County)Ohio (Wyandot County)OklahomaOntarioOregonPalauPennsylvaniaPrince Edward IslandPuerto RicoQuebecRhode IslandSaskatchewanSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirgin IslandsVirginiaWashingtonWest VirginiaWisconsinWyomingYukon Territory
24Zip:
25Country:	United StatesAfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBosnia and HerzegowinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos (Keeling) IslandsColombiaComorosCongoCook IslandsCosta RicaCote D'IvoireCroatiaCubaCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEast TimorEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEthiopiaFalkland Islands (Malvinas)Faroe IslandsFijiFinlandFranceFrance, MetropolitanFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuineaGuinea-bissauGuyanaHaitiHeard and Mc Donald IslandsHondurasHong KongHungaryIcelandIndiaIndonesiaIran (Islamic Republic of)IraqIrelandIsraelItalyJamaicaJapanJordanKazakhstanKenyaKiribatiKorea, Democratic People's Republic ofKorea, Republic ofKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyan Arab JamahiriyaLiechtensteinLithuaniaLuxembourgMacauMacedonia, The Former Yugoslav Republic ofMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesia, Federated States ofMoldova, Republic ofMonacoMongoliaMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNetherlands AntillesNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorthern Mariana IslandsNorwayOmanPakistanPalauPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarReunionRomaniaRussian FederationRwandaSaint Kitts and NevisSaint LuciaSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSeychellesSierra LeoneSingaporeSlovakia (Slovak Republic)SloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSpainSri LankaSt. HelenaSt. Pierre and MiquelonSudanSurinameSvalbard and Jan Mayen IslandsSwazilandSwedenSwitzerlandSyrian Arab RepublicTaiwanTajikistanTanzania, United Republic ofThailandTogoTokelauTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTurks and Caicos IslandsTuvaluUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUnited States Minor Outlying IslandsUruguayUzbekistanVanuatuVatican City State (Holy See)VenezuelaViet NamVirgin Islands (British)Virgin Islands (U.S.)Wallis and Futuna IslandsWestern SaharaYemenYugoslaviaZaireZambiaZimbabwe
30Phone Number:
40Church Name:
41Church City & State:
70Additional Information Other useful information might go here.
71Special Needs wheelchair, hearing, allergies, etc.
72Send Housing Info:	--YesNo
74Age: