LADY'S DAY LIFE'S MOSAICS Registration Form
Church of Divine Revelation
Name
First Name
Last Name
Phone Number
-
Area Code
Phone Number
Email
example@example.com
ARE YOU INTERESTED IN BEING ON A FUTRUE PANEL?
DO YOU HAVE A SPECIFIC DISIPLINE YOU WOULD LIKE TO SEE PRESENTED ON? IF SO, PLEASE DESCRIBE BELOW.
Additional Comments or Special Requests
In an effort to maintain social distancing, please sign the acknowledgement that you as a guest of Lady's Day Life's Mosaics/Church of Divine Revelation you will adhere to the national COVID-19 guidelines by social distancing and wearing a mask.
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