New Facilitator Information Form

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Welcome New Facilitators! Congratulations on completing training to become a Healthy CongregationsWorkshop facilitator. As you know, you are now able to purchase workshops and other resources. In order to serve you better in the future, we would like you to provide some basic information. We will use this information to verify your status as a trained facilitator when your order materials and to send periodic updates about advanced training workshops. We will NOT sell your personal information or release it to other organizations.

Title *

First and Last Name *

Phone Number *

Email *

Street Address *

City *

State/Province *

Denominational Affiliation *

Judicatory Affiliation (Synod/Diocese/Presbytery) *

Name of the Healthy Congregations facilitator who trained you *

Date you were trained *

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