gli-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.
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 Credit Card
- Master Coach Training (CC)
- I have a pre-paid code
PrePaid/Coupon Code
Total
$0.00
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
Supported Credit Cards: 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
Comments
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Tell us about yourself

Tell us about your education and experience in church planting.

Payment Options

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Church Name	Location	Size	Your Role