School for Urban Cross-Cultural Church Planting

Registration Form

Name of Team Leader
Ministry, Denomination, or Church name
Church plant name
Address
City
State
ZIP code
Phone
Email

Name of Supervisor/Overseer
Phone
Email

Other team members who will be attending:
Name & Gender (for housing purposes)			Position on Team (Primary, Support, etc)







Please describe the target area (and ethnic makeup) where you plan to plant a church:


Please print this form and fax and/or mail with payment to: World Impact attn: Don Allsman 2001 S Vermont Ave Los Angeles, CA 90007 (323) 735-1137 x325 (323) 735-2576 email: cps@worldimpact.org

Registration is due: Two months prior to each School.

Cost for the School is $485 per person. (Scholarships may be available)
This includes materials, food, lodging and transportation from airport. (Transportation to the School is not included)

Make checks payable to "World Impact". MasterCard & VISA accepted
If you would like to pay by credit card, please call

(323) 735-1137 x391

Upon receipt of this registration form, World Impact will send you:

The pamphlet and video required in the pre-requisites
Verification of registration
A Fact Sheet about the School
A map to our location.
An explanation of our process of Certification
A pamphlet entitled "Church Planting Movements"