IN-PERSON: Seven Churches of Revelation, Fall 2023

IN-PERSON: Seven Churches of Revelation, Fall 2023
Please select your class from the list below:*

PBC (Phoenix Bible Church)CSV (Church at Sun Valley)
Choose your PBC leader from the list below:*

I'm flexible! Place me in any group.Lynne AultSusan BramlettRuth Ann CarrMelissa CribbinsJulie DeSeelhorstLisa GuruleRuth JonesGina Koepp & Billie WaresDiane KuiperChris Midyett
Choose your CSV class day/time & leader from the list below:*

TUESDAY AM (leaders TBD)Thursday AM - Judith Larry-BerryThursday AM - Marianna StephensThursday AM - I'm flexible! Put me in any Thursday AM groupTHURSDAY EVENING - Mindy Scott (6-8 pm)
NAME*

First NameLast Name
EMAIL*
example@example.com
ADDRESS*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
HOME PHONE

Area CodePhone Number
CELL PHONE

Area CodePhone Number
PRIMARY PHONE: Which phone number should we use to contact you?*

HomeCell
AGE*
NAME TAG: Please type your FIRST name as you wish it to appear on your Name Tag.*
Preferred First Name
IN CASE OF EMERGENCY: Please enter the FIRST and LAST NAME of the person we can contact in the event of a medical emergency.*
Full Name of Emergency Contact
IN CASE OF EMERGENCY: Please enter the PHONE # of your emergency contact named above.*

Area CodePhone Number
MEDICAL INFO: Please describe any medical conditions we need to be aware of in the event of an emergency (e.g., heart problems, blood pressure, diabetes, life-threatening allergies, etc.).
MOBILITY/HEARING: Please indicate any mobility or hearing concerns so that we can place you in an appropriate room for small group discussion.*

Wheelchair or walker needed for walkingI cannot climb stairsRestricted - I am unable to walk long distancesI have difficulty hearingGood - I have NO mobility/hearing limitations
MARITAL STATUS: What is your marital status?*

SingleMarriedDivorcedWidowed
CHURCH: What church do you regularly attend?*
Church Name
VOLUNTEERS are needed! Please check any areas you are willing and able to serve in THIS semester. (All volunteers must arrive early. Training will be provided.)

Coffee Team (help set up and clean up)Hospitality Team (greet and assist arriving class members)Tech Team (sound, lights, PowerPoint, lecture recording)
SMALL GROUP: If possible, would you like to be placed in the same small group you had last semester?*

Same Group: Yes, please!No, I would love to meet new people!I'm flexible, place me anywhere you think best.I'm new!
Small Group FRIEND #1: Please type in the NAME of a friend you would like to have in your small group (limit ONE name here).
Name of Friend
Small Group FRIEND #2: Please type in the NAME of a second friend you would like to have in your small group (limit ONE name here).
Name of Friend
PLACEMENT PREFERENCE: In the event we cannot honor both your small group request and your friend request, which would you prefer we honor?

With Friends: I would prefer to study with my FRIENDS, even if it means I cannot be in the same small group.With Same Group: I would prefer to stay in the SAME SMALL GROUP, even if it means I cannot be in group with my friends.
SCHOLARSHIP NEEDED: Due to financial need, I would like to request a scholarship for my registration fee and study book.*

No scholarship is needed.Due to financial need, I am requesting a scholarship (this covers both registration and study book).
STUDY BOOK: The study uses the book "Revelation: Discovering Life for Today and Eternity" by Sue Edwards. LifePoint has purchased these books at a discounted rate and your study registration includes the cost of the book.*

I understand that the study book is included with my registration fee and I will receive the book on the first day of class.
PAYMENT OPTIONS: Please select one of the following options to indicate how you will pay for your registration and/or lesson binder.*

Online: I would like to pay ONLINE (after you submit this form, you will be redirected to an online payment screen).In-person: I will pay IN PERSON on the first day of class (cash or check only).
HEALTH SAFETY: If I am sick with cold or flu-like symptoms, I will stay at home or wear a mask to avoid exposing my fellow class members.*

Yes, I will act to protect the health of my fellow class members.
If you need assistance with your registration, please contact Lynne at 602-689-5747 or email us at LifePointRegistrar@gmail.com for help.
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