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Young Ladies Discipleship Onsite Registration
Registration form for the 2021 Discipleship Program for young Ladies to be held February 2 through March 1, 2021 on the Love and Purity Ministry Campus.
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Email
*
Your email
Applicant's Full Name
*
Your answer
Age (as of February 2, 2021)
*
Choose
18
19
20
21
22
23
24
25
26
27
28
29
30
Address: Street, City, State, Zip Code
*
Your answer
Applicant's Phone Number
*
Your answer
Parent (or Guardian) Full Name(s)
*
Your answer
The dates of the event are Feb 2 to Mar 1, 2021. What dates do you plan to arrive and depart?
*
Arriving Feb. 1 - Departing March 1. 2021
Other:
How did you hear about this discipleship program?
*
Your answer
Do you have any food allergies or restrictions?
*
Your answer
Payment of the program fee will be made by the following method:
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PayPal
Credit/Debit Card
Check
Other:
Any other comments or questions:
Your answer
I will abide by the event's rules and guidelines (refer to
www.loveandpurity.com/event-guidelines
for rules and guidelines)
*
yes
Required
A copy of your responses will be emailed to the address you provided.
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