LIFT International Membership Form
Name
First Name
Last Name
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Phone Number
-
Area Code
Phone Number
Email
example@example.com
Date of birth
-
Month
-
Day
Year
Date
Married/Single
Married
Single
Spouses Name
How long have you been married?
Do you work outside the home? If so where?
Give a brief summary of your testimony, including where you are today.
Why do you desire to be in a mentoring/coaching relationship?
What do you hope to gain from being in this group?
What are your expectations of the mentor/coach?
Are you aware of the requirements for the group?
Membership Plans
prev
next
( X )
Monthly Royal Package
$
50.00
Elite Annual Package
$
150.00
Pearl Annual Package
$
250.00
Diamond Annual Package
$
500.00
Platinum Annual Package
$
800.00
Total
$
0.00
Credit Card
Submit
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