Fall 2022 / 40 Days for Life 365 Application

Fall 2022

Vigil Leader Application

September 28 - November 6
Leader Application

40 Days for Life 365

July 1, 2022 - June 30, 2023

(includes both spring and fall campaigns)
If you are intending to apply for 40 Days for Life 365, STOP! The 40 Days for Life 365 application must be accessed through the 40 Days for Life Univesity webpage.
NOTE: The application MUST be completed and electronically signed by the person who will be the actual campaign leader.

Filing of this application constitutes your agreement to receive 40 Days for Life communications including e-mails.
Please answer the following questions:
1. Do you affirm that you are 18 years of age or older? *

Yes No
2. Do you affirm that you are not in any capacity associated with, or a supporter of, Planned Parenthood, any other abortion provider or referral agency, or any abortion advocacy group? *

Yes No
3. Do you pledge to hold your 40 Days for Life vigil at one and only one site during your campaign to maximize the impact of your effort? *

Yes No
4. Do you commit to strive for peaceful vigil coverage of a minimum of 12 hours per day at your vigil site for each of the consecutive 40 days of this campaign? *

Yes No
5. Do you pledge that you will complete (or have previously completed) all video training modules and to conduct your campaign in accordance with their guidance? *

Yes No
6. Do you pledge to use 40 Days for Life training materials, logos, trademarks and resources only for purposes directly related to this 40 Days for Life campaign? *

Yes No
7. Do you pledge to keep completely separate from your local 40 Days for Life efforts: *

• Advocating for or against any candidate for elective office

• Advocating for or against any proposed or actual legislation or ballot initiative
7. Keep separate political activity? *

Yes No
8. Do you pledge to conduct yourself and your 40 Days for Life campaign in a positive manner with respect, professionalism and a compassionate, Christ-like attitude? *

Yes No
9. Do you pledge to conduct yourself and your 40 Days for Life campaign in a peaceful, law-abiding manner and to obey the instructions of law enforcement officials, as well as all local, state, and federal laws? *

Yes No
10. Do you pledge to avoid engaging in any physical altercations? *

Yes No
11. Do you pledge to avoid speaking or acting in a way that is intended to harm, intimidate, frighten, antagonize or insult others? *

Yes No
12. Have you ever been convicted of a felony; judged mentally incompetent; been the subject of a founded complaint by social services and/or a child protective services agency; and/or been convicted of any crimes against minors? Or are you wanted or are there warrants out for your arrest in any jurisdiction? *

Yes No
If yes, please provide details:
13. Please list two personal references and let them know that they may expect a phone call from the 40 Days for Life headquarters team.
Reference #1 Name and phone number *
Nature of Relationship (i.e. pastor, friend, etc.) *
Reference #2 Name and phone number *
Nature of Relationship (i.e. pastor, friend, etc.) *
Please enter your information:
First Name *
Last Name *
Email *
example@example.com
Gender *

Male Female
Street Address *
City *
State / Province *
Postal / Zip Code *
Country *
Is this address a PO Box? *

Yes No
Paying Country? *

Yes No

End - Shipping Address
Phone Number *
Phone Number *
Secondary Phone Number
Secondary Phone Number

Please answer the following questions:

Please enter your information:

Please enter the vigil information:

Please enter the full address of the vigil location: