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Contact

US Office
P.O. Box 17982
Irvine, CA 92623-7982
USA
tel/fax: 949-660-1236
email: ushq[at]jcfn.org


Japan Office
OCC Bldg
2-1 Kanda Surugadai
Chiyoda-ku, Tokyo 101-0062
Tel/Fax:03-5217-2505
e-mail: nihon[at]jcfn.org



 
The following form will be used for information we would need in order to provide follow-up care for you or a friend of yours. Please fill it out and submit it to JCFN and we will contact you after we receive it.
Last Name:
  *
First Name:
  *
Street Address:
  *
City:
  *
State/Pref.:
  *
Zip Code:
  *
Country:
Phone:
  *
Fax:
E-mail:
  *
Is this request yours or your friend's?:
Myself
Friend
Last Name:
First Name:
Planned Moving Date (month/date/year):
Date of Birth (YY/MM/DD):
Sex:
Male
Female
Marital Status:
Single
Married
Is it ok to be contacted by JCFN after moving?::
Yes
I would prefer initiating my own contact.
(2) Returnee's (or moving person's) Current Address: Street :
City:
State/Pref.:
Zip Code:
Country:
Phone:
Fax:
E-mail:
Nearby Train Line:
Nearby Train Station:
(3) New Location: Street Address::
City:
State/Pref.:
Zip Code:
Country:
Phone:
Fax:
E-mail:
Nearby Train Line:
Nearby Train Station:
4) What kind of information would you like to receive?:
Church to attend near by my house
JCFN activities
Campus ministries
Christians who had been overseas, or fellowship of returning Christians
Any nearby Christian fellowship or gathering held beside Sunday
Missionary who lives nearby
Nearby Christian book stores
Bible Colleges or Seminaries in North America
Bible Colleges or Seminaries in Japan
Mission organizations
Other:
(5) When did you (your friend) accept Jesus Christ? (MM/YY):
Where? (State/Pref., Country):
If you are baptized, when ? (MM/YY):
When? (MM/YY):
Where? (State/Pref., Country):
Church Name:
Please write down any concern or hope regarding your return.:
Security Code

Security Code:
SP
RL
* Required field