A Leadership Journey Couple Registration Form

Please plan on 10 - 15 minutes to complete this form.

HUSBAND'S BASIC INFORMATION:

First Name:

Last Name:

Date of Birth:

Gender:

Home Address 1:

Home Address 2:

City:

State/Province:

Zip Code:

Country:

Home Phone (10 digits):

Cell Phone (10 digits):

Preferred Email Address:

Confirm Email Address:

Website URL:

Marital Status:

Spouse's name:

Anniversary Date:

Children's Name (and Ages):

HUSBAND'S CAREER/MINISTRY INFORMATION:

Current Career/Position:

Company/Organization:

Work Address 1 (optional):

Work Address 2 (optional):

City:

State/Prov.:

Zip Code:

Country:

Work Phone (10 digits):

Work Email (optional):

HUSBAND'S SPIRITUAL INFORMATION:

When and how did you become a Christian?

What is your church heritage?

What church you are currently attending?

What are you Spiritual gifts/other abilities? (optional)

What are you passionate about?

Current serving role(s) at your church:

HUSBAND'S ALJ INFORMATION:

The primary things I hope to get out of ALJ are:

WIFE'S BASIC INFORMATION:

First Name:

Last Name:

Date of Birth:

Gender:

Cell Phone (10 digits):

Preferred Email Address:

Confirm Email Address:

Website URL:

WIFE'S CAREER/MINISTRY INFORMATION:

Current Career/Position:

Company/Organization:

Work Address 1 (optional):

Work Address 2 (optional):

City:

State/Prov.:

Zip Code:

Country:

Work Phone (10 digits):

Work Email (optional):

WIFE'S SPIRITUAL INFORMATION:

When and how did you become a Christian?

What is your church heritage?

What church you are currently attending?

What are you Spiritual gifts/other abilities? (optional)

What are you passionate about?

Current serving role(s) at your church:

WIFE'S ALJ INFORMATION:

The primary things I hope to get out of ALJ are: