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TJD Retreat Agency Application

If you are applying to be a coach or registering to represent your agency on Saturday only, please complete the form below.  When you have been approved, you will be notified so that you can return to this page and make your payment. 

ALREADY REGISTERED AND APPROVED? ENTER YOUR EMAIL ADDRESS TO MAKE PAYMENT.

Email:

Please complete all fields.
Email Address:
Selected Retreat:
First Name:
Last Name:
Gender: Male Female
Birthdate:
MonthDayYear
Marital Status:
Spouse Name:
Spouse Birthdate:
MonthDayYear
Mailing Address:

City:
State:
Zip Code:
Preferred Phone:
Agency Name:
Position Title:
Applying For: Coach for Entire Weekend plus Booth
Saturday Only Agency Representation
Status:
Missions Experience:

Administration or Business
Adult Ministry
College Ministry
Children or Youth
Computers and Technology
Education
Evangelism and Church Planting
Humanitarian Aid
Media and Communications
Medical
Music and Worship
Urban Ministry
Other; explain below
Experience/Status Comment:

How did you learn about TJD?

Your Church Name:
Optional Comments:

Registering As:
3268   Enter number code at left to prove you are a real person.