JD Revolution – Introductory Session

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 or Organisation

Are you a member of a Church or Organisation? (required)
 Yes No

If Yes, please state your Church's or Organisation's name

Please state which area you are involved with in your Church or Organisation.
If you are not involved in your local Church, please state where you are serving locally within the Body of Christ (e.g. Missions, Charity work, etc)

Previous Discipleship Experience

Have you given discipleship or mentoring to anyone before?
 Yes No

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

Discipler's Workshop

Will you be interested in attending the next Discipler's Workshop Session?
 Yes No Not Sure Yet

If Yes, Can we keep your details on record?
 No Yes

Dietary Needs

Do you have any dietary needs that we may need to know?
 Yes No

If Yes, please give us more details

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 course, I do so with an intention to attend ALL the required sessions and to actively seek to give discipleship to a fellow Christian within 3 months of this course.

I Agree: