Heart of Rubies Corporation
321 N Main Street, Suffolk VA 23434 contactus@heartofrubis.org - www.heartofrubies.org 757-514-8446
Membership Questionnaire
Name
*
First Name
Last Name
Phone Number
Please enter a valid phone number.
Email
*
example@example.com
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
How old are you?
18-25
26-35
36-45
46-55
56-65
Other
How did you hear about us?
A Member
A Friend
A Family Member
Volunteer
Social Media Ad
Event
Other
How would you describe your walk with Jesus Christ?
I am not currently walking with Jesus, but I am open to learning more about Him.
I have a church home, but I'm not saved or have a personal relationship with Jesus
I am unsure of my standing or relationship with Jesus at this time
I am spiritual, but do not have a personal relationship with Jesus
My walk with Jesus involves consciously resisting worldly influences and aligning my actions with biblical principles
I prefer not to answer
Are you active on social media? (ie: Facebook, Twitter, or Instagram)
Yes
No
If so, what is your handle?
How often do you check your social media per day?
Randomly Throughout the Day
In the Morning
On My Lunch Hour
At Night
On the Weekend
N/A
How often do you check your email?
Several Times Throughout the Day
In the Morning
On My Lunch Hour
At Night
On the Weekend
What are some of your talents and/or giftings?
Are you open to traveling with the organization to different locations outside your home city?
Yes
No
Are you interested in volunteering?
Yes
No
Are you interested in helping others?
Yes
No
Are you interested in learning more about the organization?
Yes
No
Are you able to commit to a monthly or annual donation for membership?
Yes
No
Are you interested in learning more about training, events, or online courses?
Yes
No
If we were to sell merchandise in the future, what items would you be most interested in? Check all boxes that apply.
T-Shirts
Mugs
Bible Covers
Calendars
Keychains
Phone Covers
Planners
Canvas Bags
What T-shirt size are you?
Child/x-small
XL
Small
XXL
Medium
XXL
Large
Other
By submitting this form, you agree to receive email, calls, or text message communications from us. Please check the box below to provide your consent.
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Yes
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