A Leadership Journey Individual Registration Form

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, if married:

Anniversary Date, if married:

Children's Name (and Ages):

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):

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:

ALJ INFORMATION:

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