Student Registration

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MOBILIZE COORDINATOR

Program*
- Local Leadership Development (LLD)
- Lay Ministry Worker (LMW)
If you are unsure of your program, look at the name on your Mobilize notebook.
The level of Mobilize in which you are registering:
- Level One
- Level Two
The level of Mobilize in which you are registering:*
- Level One: Part A
- Level One: Part B
- Level Two: Part A
- Level Two: Part B
Identify your ministry specialization:*
- Cell-Group Ministry
- Children's Ministry
- Christian Education
- Counseling
- Evangelism
- Marriage and Family
- Men's Ministry
- Music
- Prayer
- Stewardship
- Teaching
- Women's Ministry
- Youth Ministry
Date Program Began*
MM
DD
YYYY
Will your spouse be participating in Mobilize?*
- Yes
- No
Student's Name*
First Middle Last
Student's Email Address*
Student's Phone Number*
Student's Birth Date*

YYYY
MM
DD
Student's Gender
- Male
- Female
Spouse's Name
First Middle Last
Spouse's Email Address
Spouse's Phone Number
Spouse's Birth Date

YYYY
MM
DD
Spouse's Gender
- Male
- Female
Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Age
- Under 25
- 26-40
- 41-54
- 55-up
Marital Status
- Single
- Married
- Widow/Widower
Name of Spouse
The level of Mobilize in which you are registering:
- Level One
- Level Two
The level of Mobilize in which your spouse is registering:*
- Level One: Part A
- Level One: Part B
- Level Two: Part A
- Level Two: Part B
Identify your spouse's ministry specialization:*
- Cell-Group Ministry
- Children's Ministry
- Christian Education
- Counseling
- Evangelism
- Marriage and Family
- Music
- Prayer
- Stewardship
- Teaching
- Women's Ministry
- Youth Ministry
**Married couples who choose separate specializations will be considered single participants.
Pastor's Name*
Church's Name*
Church's Location*
City State / Province / Region ZIP / Postal Code Country
Are you a member of the Church of God?
- Yes
- No
Where?
Is your spouse a member of the Church of God?
- Yes
- No
Where?
Have you received the baptism in the Holy Spirit with the evidence of speaking in tongues?
- Yes
- No
Are you consistent in church attendance?
- Yes
- No
Are you consistent in tithing?
- Yes
- No
Have you been baptized in water?
- Yes
- No
Describe your present ministry activities in the local church:*
List areas of ministry in which you feel most effective:*
What are your expectations regarding this Mobilize Program?*
What will you do to fulfill these expectations regarding this program?*