Discipleship Program Request

Thank you for your interest in becoming a disciple!
The first step in the process is to complete the form below.

* Indicates required field

Name *

First

Last

Date of Birth *

Email *

Phone Number *

Address *

Line 1

Line 2

City

State

Zip Code

Country

Attendance at a local assembly/church is vital to spiritual growth, however if you are not currently attending a local assembly/church, it does not disqualify you from the program.
Are you an active member of a local assembly/church?

Choose one *

Yes No

If you are currently an active member of a local assembly/church please write in the space below the name of the church, the city and state of it's location and the name of the Senior Pastor.

Local Assembly Information *

Each disciple is required to choose whom you would like to mentor you. Mentors are not assigned automatically, but can be switched at any time. It is important that you pray and seek the Holy Spirit for guidance to who He wants you to connect with.

Spiritual Mentor *

You are on your way to discipleship!
Once the form is submitted, a mentor will contact you within 3-5 business days to speak with you and share more details about the program.

I agree to receiving marketing and promotional materials *

Submit