Cultivate Coach Training Registration

Tell us about yourself

Name*

First Last

Email*

Enter Email Confirm Email

Phone*

Address*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Why are you enrolling in Cultivate Coach Training?

I am with a church or network that will use Cultivate to train church planters.
I am interested in becoming a Cultivate Coach Partner
Other* please list below in other responses

Which agency are you working with?

CMC Coach Training Wesleyan Cohort Dates

Please choose from 1 of the following start dates. Keep in mind that spots are limited to a 10/per group maximum. If you choose a group that is fill you will be contacted by CMC to discuss other options.

Which Converge Location

Other Response*

Please share why you are enrolling in Cultivate Coach Training.

Church/Network Name*

Please tell us the name of the church or church planting organization with whom you are associated.

Church/Network Location*

Church/Network website

Tell us about your education and experience in church planting.

Education Information*

Please tell us about your education history; degrees held, schools graduated from, etc.

Have you attended seminary?*

Yes
No

Seminary Name, Location & Degree*

My church planting experience includes...*

List the Church information for the churches you have helped plant.

Church Name	Location	Size	Your Role

Tell us about the demographic profile for who you reached

urban, rural, impoverished, 25-35yr olds, etc... describe the majority you reached

Explain the culture of the churches you worked in.

(ex: "come-as-you-are," laid back, formal, diverse, multi-cultural, traditional, etc.)

Payment Options

Please choose your method of payment and enter any coupon codes below.

Coach Training Payment Option*

Full by Check
Full by Credit Card
2 payments by Credit Card
Master Coach Training (CC)
I have a pre-paid code

PrePaid/Coupon Code

Total

I understand that I will be charged 1 more installment on the same day of next month.*

Yes

Credit Card*

American Express

Discover

MasterCard

Visa

Card Number Expiration Date Security Code Cardholder Name

Billing Address*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Additional Comments

Phone

This field is for validation purposes and should be left unchanged.

Please use the following form to register for the Cultivate Coach Training Program.

Tell us about yourself

Tell us about your education and experience in church planting.

Payment Options

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