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INFORMATION FOR TUKS MISSIONS COMMITEE:
Please complete the following form as thoroughly as possible and send it back before 1 April. You can send it to us in one of the following ways: Name of Organization: _____________________________________________________________

Provide the following information about your office closest to Pretoria :

Postal Address & Code:_____________________________________________________________

_______________________________________________________________________________

Physical Address: _________________________________________________________________

Landline Phone Number: 0


















Fax Number: 0



















E-mail address:____________________________________________________________________

Website address (URL): http://www.____________________________________________________ Provide the following about the person who will have contact with TMC

Name: __________________________________________________________________________

Personal e-mail address: ____________________________________________________________

Landline phone number: 0

















Cell phone/Mobile number: 0


















Provide us shortly with more information about your organization:

Vision: __________________________________________________________________________

________________________________________________________________________________

________________________________________________________________________________

________________________________________________________________________________

Mission : ________________________________________________________________________

________________________________________________________________________________

________________________________________________________________________________

________________________________________________________________________________

Goals: ________________________________________________________________________________

________________________________________________________________________________

________________________________________________________________________________

________________________________________________________________________________ Information about Projects: Please answer the following questions for each project you run <<
You are welcome to attach a brochure or pamphlet with the needed information.
(Please duplicate this page for each project you run)


Name of Organization:______________________________________________________________

Project name: _____________________________________________________________________

Short description/details: ____________________________________________________________

________________________________________________________________________________

________________________________________________________________________________

________________________________________________________________________________

________________________________________________________________________________

________________________________________________________________________________

To which town/city/area/country: ______________________________________________________

Target group: _____________________________________________________________________

When(Beginning & End): ____________________________________________________________

Starting point:_____________________________________________________________________

Type of outreach (e.g. evangelism):______________________________________________________

Requirements:_____________________________________________________________________

_________________________________________________________________________________

Training: _________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

Cost per person: ____________________________________________________________________

Closing date for applications: __________________________________________________________

Contact person for project: ____________________________________________________________

Contact details for this person (Tel, Cell, e-mail etc) : _________________________________________

_________________________________________________________________________________

May this information be placed on the Internet? (We will be discreet in this regard.)
Yes No

May this information be placed in the Sparkplug? (We will be discreet in this regard.)
Yes No

Would you classify the project as “sensitive”? (Such projects' details will be kept at our office and only be made known on request to students with those specific needs.)
Yes No

Please supply the following information: Please write down any questions you may have:
_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

Agreement:

We,__________________________________________________________________________ [NAME OF ORGANIZATION] hereby undertake to appoint a person who will be responsible for the relationship with Tuks Missions Committee and us. We further undertake to provide Tuks Missions Committee with the following information continuously: Thank you for completing this form. We appreciate it tremendously!

Tuks Missions Committee:

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logo Contact us : Email : inserv-at-inserv.org.za
Postal address: Inserv, P.O. Box 8416, Pretoria, 0001, South Africa
Telephone: +27 012 323 0915, Fax: +27 012 328 4596

Sponsored by Communications Ministries Network http://www.cmn.co.za