Registration June 22-25, 2021 *Please note: this workshop will be held 10:00 am – 6:30 pm CDT* Step 1 of 2 50% Church/Organization Name* Church/Organization Address* Street Address Address Line 2 City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Do you have a different mailing address?* Yes, I would like to provide a different mailing address No, I would prefer to use the address listed above Mailing Address Street Address Address Line 2 City State / Province / Region ZIP / Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongo, Democratic Republic of theCongo, Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzech RepublicCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatini (Swaziland)EthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacauMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth KoreaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussiaRwandaRéunionSaint BarthélemySaint HelenaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth GeorgiaSouth KoreaSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan Mayen IslandsSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTurks and Caicos IslandsTuvaluUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaVietnamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Country Your BeFriender Ministry Program* New Existing Restarting How many people are you registering?*(ie: 2, include yourself) How many are retaking BeFriender Ministry Leadership training?012345Please contact the BeFriender Office by email or at to 866-468-8708 register teams larger than 5. Prefix for Your Name TagRev.PastorYour Name* First Last Your Cell Phone*Your Work PhoneHome PhoneYour Email*Your Foundations for BeFriender Minsitry preparation email will be sent 7-10 days prior to the workshop. Your current role* Pastor BeFriender Volunteer Staff Other If you selected Staff or Other as your role, please describe Prefix for Team Member 2's Name TagRev.PastorTeam Member 2 Name* First Last Team Member 2 Cell PhoneTeam Member 2 Work/Home PhoneTeam Member 2 Email*Your Foundations for BeFriender Minsitry email will be sent 7-10 days prior to the workshop. Is your preferred mailing address the church address listed above or a home address?* Yes, I would like to use the church/organization address No, I would like to provide a home address Team Member 2's Home Address Street Address City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Current role of Team Member 2* Pastor BeFriender Volunteer Staff Other If you selected Staff or Other, please explain your role Prefix for Team Member 3's Name TagRev.PastorTeam Member 3 Name* First Last Team Member 3 Cell PhoneTeam Member 3 Work/Home PhoneTeam Member 3 Email*Your Foundations for BeFriender Ministry email will be send 7-10 days prior to the workshop. Is your preferred mailing address the church address listed above or a home address?* Yes, I would like to use the church/organization address No, I would like to provide a home address Team Member 3's Home Address Street Address City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Current role of Team Member 3* Pastor BeFriender Volunteer Staff Other If you selected Staff or Other, please describe your role Prefix for Team Member 4's Name TagRev.PastorTeam Member 4 Name* First Last Team Member 4 Cell PhoneTeam Member 4 Work/Home PhoneTeam Member 4 Email*Your Foundations for BeFriender Ministry email will be send 7-10 days prior to the workshop. Is your preferred mailing address the church address listed above or a home address?* Yes, I would like to use the church/organization address No, I will provide a home address Team Member 4's Home Address Street Address City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Current role of Team Member 4* Pastor BeFriender Volunteer Staff Other If you selected Staff or Other, please describe your role Prefix for Team Member 5's Name TagRev.PastorTeam Member 5 Name* First Last Team Member 5 Cell PhoneTeam Member 5 Work/Home PhoneTeam Member 5 Email*Your Foundations for BeFriender Ministry email will be send 7-10 days prior to the workshop. Is your preferred mailing address the church address listed above or a home address?* Yes, I would like to use the church address No, I will provide a home address Team Member 5's Home Address Street Address Address Line 2 City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Current role of Team Member 5* Pastor BeFriender Volunteer Staff Other If you listed Staff or Other, please explain Date MM slash DD slash YYYY Early Registration Fee Price: $799.00 Quantity: Registration Fee Price: $849.00 Quantity: Workshop DiscountDiscount for people who have previously attended a BeFriender Foundations Workshop $0.00 Workshop DiscountDiscount for people who have previously attended a BeFriender Foundations Workshop $0.00 Workshop DiscountDiscount for people who have previously attended a BeFriender Foundations Workshop $0.00 Workshop DiscountDiscount for people who have previously attended a BeFriender Foundations Workshop $0.00 Workshop DiscountDiscount for people who have previously attended a BeFriender Foundations Workshop $0.00 I will be paying with: My personal credit card Church/organization card If you had been given a special registration code, enter it here and click apply Total $0.00 Billing Zip Code* ZIP / Postal Code Credit CardCard Details Cardholder Name PhoneThis field is for validation purposes and should be left unchanged.
