Affiliate Application Form

Church Name*

Lead Pastor's Full Name*

First Last

Is the Lead Pastor an MFI member?*

Lead Pastor's Email*

Church Address*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Church Phone*

Church's Website*

Program Name

Program Director's Full Name*

First Last

Program Director's Email*

Enter Email Confirm Email

Program Director's Mobile Number*

How did you hear about PBC Affiliate Program?*

Program Website (if there is one)

The Program is considered*

Please provide a description of the program's weekly schedule*

How many months does the program run?*

How many years are offered in the program?*

Which courses are you interested in offering?*

How do you plan to teach courses?*

Would you be interested in Spanish course materials?*

Please include any other information that may be relevant to your application.

Name

This field is for validation purposes and should be left unchanged.