Curriculum Information Request Form

Please use this form to give us a little more information about what you're looking for and how we can provide for your needs!

After this has been submitted, and we've had time to do a little research, and LRM staff member will be in touch with you!
*denotes required information

First, we need a little information about you, and your church:
*Your Name:
*Church Name:
*Day-Time Phone:
*E-mail Address:
	I prefer to be contacted by phone.
	I prefer to be contacted by e-mail.
	I Will pick up the Samples
	Please ship my samples, I will pay shipping costs.

Which age areas would you like information about?
	Preschool/Kindergarten
	Elementary (1st-4th grade)
	Upper Elementary (5th-8th grade)
	Jr./Sr. High
	Adult

What is the average attendance of this class, or classes?

Do you need information on a specific publisher or curriculum we carry?


Concorida
	Growing In Christ

David C. Cook		Gospel Light
	Bible in Life	Group
	Echoes		Faith Weaver
	God Prints		Faith Weaver Friends
	Reformation Press		Hands On
	Scripture Press

Standard		Union Gospel Press

Sometimes, we can provide you with curriculum samples.
Would you like to view samples for an of the curriculums you selected above? Please note which, if any!

Yes! Please let me know if you can provide samples for:

*Please note: if you request that samples be shipped to you, we do require you to pay for the shipping costs.

Is the curriculum you're interested in not listed above?
Please give us some information about it, and we will try to research it for you!

Additional Questions

If you have any more questions or comments, please list them below.