Application for Citywide Evangelization,
Revival and Transformation Course

Please fill in the form below to apply to be part of the Citywide Evangelization, Revival and Transformation web-based training.

We will process it, trying to work out the right combination of people in each group of five participants, and the preferred times.

We should get back to you within a week.  If not, please call or email directly as we are often traveling.

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Please provide the following contact information:

Name
Title
Organization
Address
City
Country
Work Phone
FAX
E-mail
URL
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Please identify and describe yourself:

Name
Date of Birth
Sex Male Female
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Please describe your role in the city and reason for taking this course:

                               

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Please give one other city leader in your city who can act as a reference for you:

             Referees Name & Role:    

             Referees email:  

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What is your preferred times of web meeting ? (we have suggested Wednesdays,
New Zealand time(GMT +12):

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Enter the date of registration: -- dd/mm/yy


Copyright © 1999 [Urban Leadership FOundation]. All rights reserved.
Revised: 05/21/07

Last modified: 05/06/07