Registration Form
Fill out the form carefully for registration
Participant Information
Participant Name
*
First Name
Last Name
Gender
*
Please Select
Male
Female
Marital Status
*
Please Select
Divorced
Engaged
Married
Remarried
Separated
Single
Widow/Widower
Please choose your current marital status
Date Of Birth
*
-
Month
-
Day
Year
Date of birth
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Participant E-mail
*
Confirmation Email
example@example.com
Mobile Number
*
Emergency Contact Information
*
Please provide the name, relationship, email, and phone number of your emergency contact.
Do you attend church? If so, where?
*
If you do not attend church, just type "No".
Please describe your relationship with God and how you became a Christian.
*
Please describe your experience and understanding of living out of your true identity in Christ.
*
Why would you like to participate in this program?
*
I have attended/watched the By Divine Design conference.
*
Yes
No
If yes to the above, where and when did you attend/watch the By Divine Design conference?
*
Please provide the general location (or "online") and the approximate timeframe. If you have not yet attended or watched, type N/A.
References
Please provide two (2) references as outlined below. Upon submission, an email will automatically be sent requesting them to complete a reference form (please ask their permission first and let them know the email will be sent upon your application submission).
Spiritual Mentor/Pastor/Small Group Leader Name
*
First Name
Last Name
Spiritual Mentor/Pastor/Small Group Leader Name BEST Email
*
Confirmation Email
example@example.com
Additional Reference Name
*
First Name
Last Name
Additional Reference BEST Email
*
Confirmation Email
example@example.com
Availability
Please mark ALL availability for The Encounter sessions (choose at least two).
9:00AM-12:00PM EST
1:00PM-4:00PM EST
6:00PM-9:00PM EST
Monday
Tuesday
Wednesday
Thursday
Friday
Final Check
Please check the below to indicate your agreement.
*
I agree with the Grace Ministries International statement of faith which can be found at https://gmint.org/statementofaith
Please check the below box to complete your registration.
*
I agree to pay the $26 application fee (covers TJ assessent) and the $1,200 program fee prior to the program start date or over the course of the program as scheduled by Grace Ministries International.
Any final comments?
Please verify that you are human
*
Submit Application
Clear Fields
Should be Empty: