Church Renewal Weekend Registration Form

Church Renewal Round Table Registration

SPECIAL GUESTS

Ray & Fran Duerksen

Founder & Directors, Church Renewal Ministry

Former Lead Pastor (22 yrs) Southland Church, Steinbach MB

HOSTED BY

Mark Peterkins
One Way Ministries

John & Lorraine Baergen
Canadian Coordinators, Church Renewal Ministry

First name:

Last name:

Email:

Phone:

Mailing address:

City:

Country:

Province/State:

Postal Code:

Age:

Gender: Male Female

Marital status:

Do you need translation? No Yes

Name of home church:

Size of church: (weekly attendance)

Denomination:

Are you currently in Church Renewal mentoring? Yes No

Position in Church/Org./Denomination:

For all enquiries, email info@churchrenewal.com