Virtual BeFriender Candidate Training Registration Prior to registering your candidates for training, please read Program Leader Expectations and Responsibilities. 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 Active BeFriender Program Leader to serve as contact person during training: Name* First Last Program Leader Cell*Program Leader Email* How many candidates are you registering?*(ie: 2) Please contact the BeFriender Office by email or at to 866-468-8708 register teams larger than 5. Candidates must participate in all training dates within the session selected. All times indicated are Central Time.Candidate 1 Name* First Last Candidate 1 Cell Phone Number*Candidate 1 Email* Select the session the candidate will be attending* October 16, 27, November 3, 10, December 1 February 5, 10, 17, 24, March 3 April 23, 27, May 4, 11, 18 Candidate 2 Name* First Last Candidate 2 Cell Phone*Candidate 2 Email* Select the session the candidate will be attending* September 17, 24 October 16, 27, November 3, 10, December 1 February 5, 10, 17, 24, March 3 April 23, 27, May 4, 11, 18 Candidate 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 Candidate 3 Name* First Last Candidate 3 Cell Phone*Candidate 3 Email* Select the session the candidate will be attending* September 17, 24 October 16, 27, November 3, 10, December 1 February 5, 10, 17, 24, March 3 April 23, 27, May 4, 11, 18 Candidate 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 Candidate 4 Name* First Last Candidate 4 Cell Phone*Candidate 4 Email* Select the session the candidate will be attending* September 17, 24 October 16, 27, November 3, 10, December 1 February 5, 10, 17, 24, March 3 April 23, 27, May 4, 11, 18 Candidate 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 Candidate 5 Name* First Last Candidate 5 Cell Phone*Candidate 5 Email* Select the session the candidate will be attending* September 17, 24 October 16, 27, November 3, 10, December 1 February 5, 10, 17, 24, March 3 April 23, 27, May 4, 11, 18 Candidate 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 Date MM slash DD slash YYYY Registration Fee Price: $180.00 Quantity: I will be paying with: My personal credit card Church/organization card Total $0.00 Billing Zip Code* ZIP / Postal Code Credit CardCard Details Cardholder Name CommentsThis field is for validation purposes and should be left unchanged. Δ
