Healthy Church Initiative Form

Instructions

*Fill in all the fields and click the submit button.
*On the confirmation page you will be directed to the payment page to conclude your registration. However, you may skip the payment step if you are only looking for information.

First Name

Last Name

Phone Number (xxx-xxx-xxxx)

Church Affiliation

District

Please Pick The Appropriate Response

Our church wishes to participate in the Shared Learning Experiences beginning January 2020. (Cost is $500.)

Our church is interested but would like a HCI staff member to come to our church to explain the process in person before we make our final decision.

To prevent spam, please tell us:

What is 6 + 3 ?*