Priority 1:16 Registration

Name

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Title*

First Name*

Last Name*

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Position at Church or School

Email*

Church Name*

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Pastor's Name

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Street Address

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Apartment / Suite No.

City*

State*

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Zip Code

Cell Phone

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Church or School Phone

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Denomination

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Average Weekend Attendance

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Weekend Service Dates and Times (e.g., Saturday at 6 PM, Sunday at 8:30 and 11 AM)

We choose the following option of partnership: (click all that apply)

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We choose the following option of partnership: (click all that apply)

I am responding to:*

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Questions, Comments, or Prayer Requests

Yes, we want to unite with God’s evangelism priority.