EmailMe Form - mission shaped ministry 2016

Your Name

First Last

Name of your home congregation or faith community?

eg Aspley Uniting Church; Southport Church of Christ, Boonah Faith Community

Your Email Address

Your Phone #:

Postal Address

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

Do you have any food allergies or requirements?

Emergency Contact Information

In the event of an emergency, who do we need to contact on your behalf?

Emergency Contact Name

First Last

Emergency Contact Phone #

Registration Type

Are you registering as an individual or registering a group for the course? If a group, we'll ask you some extra questions!

Are you registering a group, or as an individual?

Just me for full course @ $295

A group for full course @ $295 for first, $250 for subsequent participants

Just the intro intensive @ $95

If you register for the intro weekend only, we'll give you the option to extend into the full course at the completion of the intro weekend. A further fee will be payable at that time.

Group Registration Extra Details

If registering a group, please name the group

eg Chermside Cafe Church Plant; Mt Gravatt Anglican Church

If registering a group, how many registrations required?

if registering a group, list the names of your participants (if known):

Please list any food allergies/requirements for your group (including numbers for each):

eg: Gluten Free x 1; Vegetarian x 2; Peanut allergy x 1

Additional Information

What are you looking forward to about the mission shaped ministry course?

Any other comments or questions?

Payment Information

Payment of $95 (intro only) or $295 (full course) or $250 (for subsequent participants from the same group) will be due prior to the course starting. We will contact you with payment options once your registration is received.