PCAFI Community Impact Empowerment (PCIE) Registration Form

PCAFI Community Impact Empowerment (PCIE) Registration Form

The PCAFI Community Impact Empowerment (PCIE) initially focuses on knowledge sharing to build community development skills and capabilities. Over time we will build centralized technical and financial assistance capability to provide end-to-end support for our churches across the US.
Registrant Information
Name*

First NameLast Name
Address*

Street Address

Street Address Line 2

CityState

Zip CodeCountry
Council*
Church Name*
Pastor's Name
Contact Email*
example@example.com
Phone Number
Please enter a valid phone number.

Your PCIE Team

You can enter up a total of 5 team members in addition to the church pastor
Church Pastor

First NameLast Name
Pastor's Email
example@example.com
Member #1 Name (Team Leader)

First NameLast Name
Team Leader Email
example@example.com
Member #2 Name

First NameLast Name
Member #2 Email
example@example.com
Member #3 Name

First NameLast Name
Member #3 Email
example@example.com
Member #4 Name

First NameLast Name
Member #4 Email
example@example.com
Member #5 Name

First NameLast Name
Member #5 Email
example@example.com

Select your Church size

Small ChurchThis is church with a membership size of 100 or less

$500.00

Medium ChurchThis is church with a membership size of 100 - 499 members

$750.00

Large ChurchThis is church with a membership size of 500 or more members

$1,500.00

Enter coupon

Total

$0.00

Payment Methods

Debit or Credit Card

Choose from one of the PayPal options to make your payment.

Registrant Information