Assessment Individual Registration

Tell us about yourself

Name*

First Last

Email*

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Phone*

Address*

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

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Please indication which date you in which would like to participate*

Fun Facts, Hobbies, etc

tell us...tell us about you!

What you like to do in your spare time, your hobbies, your family, etc. We like all the details so do be afraid to overshare!

Church / Church Plant Information

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

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GLI Assessment Center Individual Registration

Price: $995.00 Quantity:

*cost is for event registration only. Accommodations, travel, etc. is not included and is the responsibility of those attending.

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Billing Address*

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