Name *

First Name

Last Name

Phone

(###)

###

####

Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

I am currently interested in:

Church Planting

Church Revitalization

Church Leadership / Pastoring

I am able to prioritize every first Saturday, 8am-1pm, from October through to meet with my Leadership Cohort.

Yes

No

Other

I am able to pay the $800 fee to cover training, coaching, and meals. (Payment plans available.)

Yes

No

I may need a partial scholarship