Scholarship Application for Refresh Breakaway 2022

Processed

Yes

Refresh Ministry Women Breakaway

UNSHAKABLE

March 18-19, 2022

Life360 Chesterfield - Springfield, MO

We are happy to offer scholarships when they are available to us. They will be honored first come, first served. To qualify, you must 1) need the assistance and 2) be a credentialed minister with the Southern Missouri District Assemblies of God or the spouse of a credentialed minister with the SMDAG.

Once your application has been processed, we will contact you with a separate registration form. Your information will be confidential with our office. Thank you!

REGISTRATION INFORMATION

Full Name *

First Name Last Name

Address *

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code Country

Day Phone *

Area Code Phone Number

E-mail *

Church Name *

Status *

Credentialed Minister with the SMDAG Spouse of a Credentialed Minister with the SMDAG