Witness Mobilization Program

Name *

First Name

Last Name

Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Phone

(###)

###

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Name of reference *

This is from your Church, Ministry, or Camp leader. NOTE: We will be contacting your reference to discuss your current or potential ministry role and to explore how this program can best equip you for it. The reference will also provide a means of accountability and an opportunity to discuss your areas of strength, ongoing growth, and development.

First Name

Last Name