Becoming ONE Fall Relationship Workshop Sign up hosted by Agape Child & Family Services, Inc.
(Friday, 11/15- 3:00pm to 7:30pm; Saturday 11/16 - 9:00am to 4:00pm)
November 15th and 16th at Highland Church of Christ 400 N Levee Road, Cordova, TN 38018
Fill out the form carefully to SIGN UP for the 2024 Individual's Workshop IT IS MANDATORY THAT YOU ATTEND ALL SESSIONS
Name
*
First Name
Middle Initial
Last Name
Birth Date
*
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Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
E-mail
*
example@example.com
Phone number
*
Referring Organization
*
Are You a Pastor, Minister, Chaplain, or Serve in Ministry at a Church or Faith Based Organization?
*
Please Select
Yes
No
If Yes, Please Specify Your Role
*
What is your relationship status?
*
Single
In a Relationship
Engaged
Divorced
I understand that meals are provided, however, I understand the program cannot accommodate individual dietary requirements.
*
Favorite Song and Artist
*
Individuals agree to attend the Mandatory Orientation/Kickoff via Zoom, on Friday, November 8, 2024, from 6:30-7:30 pm.
*
Yes, I will attend
No, I cannot attend this Orientation
By checking each box below, I AGREE to COMPLETE all the surveys to enroll in the Becoming One Program.
*
Please Note: PHOTOGRAPHS AND VIDEOS ARE TAKEN AT ALL OUR EVENTS.
Submit Application
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