Leadership Visitation Request Form
Your Name:
*
First Name
Last Name
Co-Leader's Name (if applicable):
First Name
Last Name
Your Email:
*
example@example.com
Your Phone Number:
*
Please enter a valid phone number. This will be the primary number we will contact you with.
Would You Prefer an In-Person or Zoom Visit?
*
Please Select
In-Person
Zoom
For those who live outside the So Cal area, please select “Zoom”
Please List 3 Possible Dates for a Visit (in preferential order) :
*
ex: August 3, 17, 21
Please Select your Preferred Leader:
*
Please Select
Pastor Yolie Arevalos
Pastor Haroon Bhatti
Pastor Mikael Burnette
Pastor Jerry Dirmann
Pastor Luke Esslinger (Young Adult HCs Preferred)
Pastor Tristan Fenholt
Pastor Anna Iervolino
Pastor Jeff Little
Pastor Tammy Sevcov
There is not a guarantee that this leader will be available on the dates you requested, but we will do our best to accommodate your request.
How Can Our Leader Best Serve You:
*
Teaching/Exhorting
Sitting-In
Other
Time for Leader to Arrive:
*
Hour Minutes
AM
PM
AM/PM Option
Location's Address:
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Any Questions? Please leave them below:
Is your House Church opened to being filmed?
*
Please Select
Yes
No
By selecting "Yes", you are consenting to any selected footage taken at your HC to be used for media purposes.
Submit
Should be Empty: