Contact Information

Your Name (required)

Date of Birth (required)

Address (required)

City or ZIP Code (required)

Mobile Phone (required)

Home/Work Phone

Your Email (required)

Church Life

Are you a member of a church? (required)
YesNo

If Yes, please state your church name

Please state which area you are involved with in your church

Previous Discipleship Experience

Have you given discipleship or mentoring to anyone before?
YesNo

If Yes, How Long was it for and how often did you meet the person?

Type of Delegate

Are you registering as a Full Delegate or a Day Delegate? (required)
Full DelegateDay Delegate

Agreement and Confirmation

Date

By submitting this application, I affirm that the facts set forth in it are true and complete. I understand that if I am accepted as a delegate on this workshop, I do so with an intention to attend ALL the required sessions and to actively seek to receive or to give discipleship to a fellow Christian within 3 months of this course.

I Agree: