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<HTML>

<HEAD>


<META NAME="description" CONTENT="Family Counseling Associates - a Christ-centered Professional Counseling Center in Indianapolis, Indiana (317) 585-1060">
<META NAME="Keywords"    CONTENT="counseling, therapy, christian, marriage, family, depression, marital, family counseling associates, Tim Heck, Jama Davis, catholic, indianapolis, therapists">


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<TITLE>Deacon Application</TITLE></head>
<BODY  BGCOLOR="#FFFFFF"
 TEXT="#000000"

LEFTMARGIN="0" TOPMARGIN="0" RIGHTMARGIN="0" BOTTOMMARGIN="0"

 onLoad=""
 
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>

  
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                                            <a href="about1.html" onMouseOver="document.images['img149'].src='widgets/gen_4250.1.gif'" onMouseOut="document.images['img149'].src='widgets/gen_4698.1.gif'"><img src="widgets/gen_4698.1.gif" alt="Psychiatrists" name="img149" border="0"></a><br>
                                            <a href="about2.html" onMouseOver="document.images['img150'].src='widgets/gen_4699.1.gif'" onMouseOut="document.images['img150'].src='widgets/gen_4251.1.gif'"><img src="widgets/gen_4251.1.gif" alt="Marriage & Family" name="img150" border="0"></a><br>
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                                            <a href="about5.html" onMouseOver="document.images['img153'].src='widgets/gen_4256.1.gif'" onMouseOut="document.images['img153'].src='widgets/gen_4255.1.gif'"><img src="widgets/gen_4255.1.gif" alt="Coaching" name="img153" border="0"></a><br>
                                            <a href="about4.html" onMouseOver="document.images['img152'].src='widgets/gen_4258.1.gif'" onMouseOut="document.images['img152'].src='widgets/gen_4257.1.gif'"><img src="widgets/gen_4257.1.gif" alt="School Counselors" name="img152" border="0"></a><br>
                                            
                                            <a href="gpage5.html" onMouseOver="document.images['img615'].src='widgets/gen_4262.1.gif'" onMouseOut="document.images['img615'].src='widgets/gen_4261.1.gif'"><img src="widgets/gen_4261.1.gif" alt="Marriage Intensives" name="img615" border="0"></a><br>
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                                            <a href="about6.html" onMouseOver="document.images['img175'].src='widgets/gen_4264.1.gif'" onMouseOut="document.images['img175'].src='widgets/gen_4263.1.gif'"><img src="widgets/gen_4263.1.gif" alt="Interns/Residents" name="img175" border="0"></a><br>
                                            <a href="form1.html" onMouseOver="document.images['img117'].src='widgets/gen_4266.1.gif'" onMouseOut="document.images['img117'].src='widgets/gen_4265.1.gif'"><img src="widgets/gen_4265.1.gif" alt="Intake Form " name="img117" border="0"></a><br>
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                                            <a href="faq.html" onMouseOver="document.images['img106'].src='widgets/gen_4286.1.gif'" onMouseOut="document.images['img106'].src='widgets/gen_4285.1.gif'"><img src="widgets/gen_4285.1.gif" alt="FAQ" name="img106" border="0"></a><br>
                                            <a href="links1.html" onMouseOver="document.images['img178'].src='widgets/gen_4288.1.gif'" onMouseOut="document.images['img178'].src='widgets/gen_4287.1.gif'"><img src="widgets/gen_4287.1.gif" alt="Internet Links" name="img178" border="0"></a><br>
                                            
                                            
                                            <a href="links2.html" onMouseOver="document.images['img566'].src='widgets/gen_4300.1.gif'" onMouseOut="document.images['img566'].src='widgets/gen_4299.1.gif'"><img src="widgets/gen_4299.1.gif" alt="Deacon Assessment" name="img566" border="0"></a><br>
                                            
                                            
                                            <a href="gpage6.html" onMouseOver="document.images['img678'].src='widgets/gen_4528.1.gif'" onMouseOut="document.images['img678'].src='widgets/gen_4944.1.gif'"><img src="widgets/gen_4944.1.gif" alt="Ask an Expert" name="img678" border="0"></a><br>
                                            
                                            
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                                            <a href="form10.html" onMouseOver="document.images['img722'].src='widgets/gen_4571.1.gif'" onMouseOut="document.images['img722'].src='widgets/gen_4570.1.gif'"><img src="widgets/gen_4570.1.gif" alt="Group Register" name="img722" border="0"></a><br><a href="mailto:gayle@fcahelp.com" onMouseOver="document.images['img_email'].src='widgets/gen_4308.1.gif'" onMouseOut="document.images['img_email'].src='widgets/gen_4307.1.gif'"><img src="widgets/gen_4307.1.gif" alt="e-mail me" name="img_email" border="0"></a><br></TD>                                     </TR>
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                                <div align="justify" style="margin-top:10px;margin-left:10px;margin-bottom:10px;">
                                <!-- BOF: ./personal-templates/simple/business/form/html -->
<!-- BOF: ./personal-templates/simple/personal/form/html -->


<center><table border=0>
<tr><td>


<font face='Arial' size='+1' color='#9D040C'>

Deacon Application

</font>


<br>
<SCRIPT LANGUAGE="JavaScript">
var BUILDER = '/servlet/psoft.masonry.Builder';
function validate(frm){
var i = 0;

if (frm.field_571.value=="") return error(frm.field_571);

if (frm.field_572.value=="") return error(frm.field_572);

if (frm.field_574.value=="") return error(frm.field_574);

if (frm.field_575.value=="") return error(frm.field_575);

if (frm.field_576.value=="") return error(frm.field_576);

if (frm.field_579.value=="") return error(frm.field_579);

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frm.domain.value=url;
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function error(field){ alert('You did not fill all required fields!'); field.focus(); return false; }
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<form name="questionary" action="http://76.74.155.84:8080/servlet/psoft.customform.CustomForm" method="post">
<input type="hidden" name="domain" value="">
<input type="hidden" name="title" value="Deacon Application">
<input type="hidden" name="esubj" value="Submitted Application">
<input type="hidden" name="name" value="=GCh0WG5bU1bal4b">
<input type="hidden" name="submit_url" value="onsubmit9.html">
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<input type="hidden" name="order" value="571 572 573 703 574 575 576 577 578 579 580 ">
<table border=0 cellpedding=5 cellspacing=5>

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<font face='Arial' size='2' color='#000000'>

First Name of Deacon Candidate

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<input type="hidden" name="name_572" value="Last Name">
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Last Name

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<input type="hidden" name="name_573" value="Spouse's First Name (If Married)">
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Spouse's First Name (If Married)

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<input type="hidden" name="name_703" value="Children (Please include names and ages)">
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Children (Please include names and ages)

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<input type="hidden" name="name_574" value="Address">
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Address

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<input type="hidden" name="name_575" value="City">
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City

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<input type="hidden" name="name_576" value="Zip">
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Zip

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<input type="text" name="field_576" size="5">


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<input type="hidden" name="name_577" value="Home Phone">
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Home Phone

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<input type="text" name="field_577" size="11">


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<input type="hidden" name="name_578" value="Cell Phone">
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Cell Phone

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<input type="hidden" name="name_579" value="E-Mail">
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E-Mail

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<input type="hidden" name="rcpt" value="field_579">


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<input type="hidden" name="name_580" value="Comments or Questions">
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Comments or Questions

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</form>
</td></tr></table></center>
<!-- EOF: ./personal-templates/simple/personal/form/html -->

<!-- EOF: ./personal-templates/simple/business/form/html -->
<br>

<br>
<FONT FACE="verdana, arial, helvetica" SIZE="1">
<center>
<nobr>|<a href="index.html">Welcome</A>|</nobr>

<nobr>|<a href="gpage1.html">FCA North</A>|</nobr>

<nobr>|<a href="gpage.html">FCA West</A>|</nobr>

<nobr>|<a href="about1.html">Psychiatrists</A>|</nobr>

<nobr>|<a href="about2.html">Marriage & Family</A>|</nobr>

<nobr>|<a href="about3.html">Counselors</A>|</nobr>

<nobr>|<a href="about5.html">Coaching</A>|</nobr>

<nobr>|<a href="about4.html">School Counselors</A>|</nobr>

<nobr>|<a href="gpage5.html">Marriage Intensives</A>|</nobr>

<nobr>|<a href="PlayTherapy.html">Play Therapy</A>|</nobr>

<nobr>|<a href="gpage9.html">Perinatal Mood Disorders</A>|</nobr>

<nobr>|<a href="about6.html">Interns/Residents</A>|</nobr>

<nobr>|<a href="form1.html">Intake Form </A>|</nobr>

<nobr>|<a href="Download.html">Forms</A>|</nobr>

<nobr>|<a href="form.html">Test Your Marriage</A>|</nobr>

<nobr>|<a href="links.html">Testing</A>|</nobr>

<nobr>|<a href="amazon.html">Books</A>|</nobr>

<nobr>|<a href="Download1.html">Articles</A>|</nobr>

<nobr>|<a href="directions.html">Directions</A>|</nobr>

<nobr>|<a href="faq.html">FAQ</A>|</nobr>

<nobr>|<a href="links1.html">Internet Links</A>|</nobr>

<nobr>|<a href="links2.html">Deacon Assessment</A>|</nobr>

<nobr>|<a href="gpage6.html">Ask an Expert</A>|</nobr>

<nobr>|<a href="news1.html">Groups</A>|</nobr>

<nobr>|<a href="form10.html">Group Register</A>|</nobr>
</center>
</font>

</div></TD>
                            <TD WIDTH=40 HEIGHT="100%" BGCOLOR="#5A7D7F" VALIGN="top" BACKGROUND="widgets/gen_4692.1.gif">
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</TR>
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                            <TD WIDTH=775 HEIGHT=71 BGCOLOR="#234244" VALIGN="top" >
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    </TD>
    
</TR>                                
<TR>
    <TD WIDTH="100%" HEIGHT="100%" BGCOLOR="#234244">
        <center>
<center><table border="0" cellpadding="0" cellspacing="3"><tr><td align="center">

<br><font face="helvetica,verdana, arial" size="1">&nbsp;</font>

</td></tr></table></center>
</center></TD>
</TR>                                        
<TR>
    <TD WIDTH="100%" HEIGHT=62 BGCOLOR="#234244" VALIGN="top" BACKGROUND="widgets/gen_4228.1.gif">
        <img src="widgets/spacer.gif" height=62 width=10 alt=""></TD>
</TR>
</TABLE>        
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