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“THE WORD” Church

SMALL GROUP REGISTRATION - MENS MONDAY GRIEF RECOVERY

Full Name(required)
Today's Date (mm/dd/yy)(required)
Member #
Email Address(valid email required)
Contact Number(required)
Alternate Number
Address
City
Zip

Are you a member of “THE WORD” Church?

Yes No
if you answered no,what is your church home? (Type 'N/A' if no church home)

Are you currently serving in ministry?

Yes No
If Yes,What Ministry
Name of Ministry Leader:

May we release information to the
Department of Ministries regarding your registration ONLY?

Yes No

May we release information to the
Department of Ministries regarding your final completion?

Yes No
* Classroom locations will be disclosed in forthcoming confirmation letter

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