40th Anniversary Virtual Celebration - Monday, June 13, 2022 - Registration

40th Anniversary Virtual Celebration - Monday, June 13, 2022

Celebrating Our Past, Present and Future. Date: Monday June 13, 2022 Time: 6:30 – 7:30 CDT Audience: Everyone is invited to participate! Fee: There is no fee to attend, however please register so we can email you the zoom link.

Name of Church or Organization*
Church or Organization Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Total number of participants you are registering*
Participant 1 Name*
First Last
Participant 1 Current Role
- BeFriender Program Leader
- BeFriender
- Other
If you selected other: please describe:
Participant 1 Email*
Participant 1 Cell Phone*
Do you have a different mailing address?*
- Yes, I would like to provide a different address
- No, I would prefer to use the church/organization address
Participant 1 Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Participant 2 Name
First Last
Participant 2 Current Role
- BeFriender Program Leader
- BeFriender
- Other
If you selected other: please describe:
Participant 2 Email
Participant 2 Cell Phone
Do you have a different mailing address?
- Yes, I would prefer to provide a different address
- No, I would prefer to use the church/organization address
Participant 2 Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Participant 3 Name
First Last
Participant 3 Current Role
- BeFriender Program Leader
- BeFriender
- Other
If you selected other: please describe:
Participant 3 Email
Participant 3 Cell Phone
Do you have a different mailing address?
- Yes, I would like to provide a different address
- No, I would prefer to use the church/organization address
Participant 3 Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Participant 4 Name
First Last
Participant 4 Current Role
- BeFriender Program Leader
- BeFriender
- Other
If you selected other: please describe:
Participant 4 Email
Participant 4 Cell Phone
Do you have a different mailing address?
- Yes, I would like to provide a different address
- No, I would prefer to use the church/organization address
Participant 4 Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Participant 5 Name
First Last
Participant 5 Current Role
- BeFriender Program Leader
- BeFriender
- Other
If you selected other: please describe:
Participant 5 Email
Participant 5 Cell Phone
Do you have a different mailing address?
- Yes, I would like to provide a different address
- No, I would prefer to use the church/organization address
Participant 5 Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Participant 6 Name
First Last
Participant 6 Current Role
- BeFriender Program Leader
- BeFriender
- Other
If you selected other: please describe:
Participant 6 Email
Participant 6 Cell Phone
Do you have a different mailing address?
- Yes, I would like to provide a different address
- No, I would prefer to use the church/organization address
Participant 6 Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Participant 7 Name
First Last
Participant 7 Current Role
- BeFriender Program Leader
- BeFriender
- Other
If you selected other: please describe:
Participant 7 Email
Participant 7 Cell Phone
Do you have a different mailing address?
- Yes, I would like to provide a different address
- No, I would prefer to use the church/organization address
Participant 7 Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Participant 8 Name
First Last
Participant 8 Current Role
- BeFriender Program Leader
- BeFriender
- Other
If you selected other: please describe:
Participant 8 Email
Participant 8 Cell Phone
Do you have a different mailing address?
- Yes, I would like to provide a different address
- No, I would prefer to use the church/organization address
Participant 8 Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Participant 9 Name
First Last
Participant 9 Current Role
- BeFriender Program Leader
- BeFriender
- Other
If you selected other: please describe:
Participant 9 Email
Participant 9 Cell Phone
Do you have a different mailing address?
- Yes, I would like to provide a different address
- No, I would prefer to use the church/organization address
Participant 9 Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Participant 10 Name
First Last
Participant 10 Current Role
- BeFriender Program Leader
- BeFriender
- Other
If you selected other: please describe:
Participant 10 Email
Participant 10 Cell Phone
Do you have a different mailing address?
- Yes, I would like to provide a different address
- No, I would prefer to use the church/organization address
Participant 10 Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Name
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40th Anniversary Virtual Celebration – Monday, June 13, 2022 – Registration

40th Anniversary Virtual Celebration - Monday, June 13, 2022

Deb

Pastor Dan

Chaplain John

BeFriender Ministry – A Listening Presence