Church Planters Collective Signup Form

* Membership Type

Church Planters Collective Free Church Planters or Prospective Church Planters

YOUR DETAILS:

* First & Last Name

* Your E-Mail Address

a confirmation email will be sent to you at this address

* Church/Organisation

* Mobile Number

* Gender

HOME ADDRESS DETAILS:

Street Number and Name

* Suburb

* Country

* State

* Postcode

CHURCH PLANT DETAILS:

Please note, we cannot accept your registration if you are planting outside of Australia

* State which of the following best describes you

Active = If you've planted a church within the last 5 years
Prospective = Planning to plant a church within the next 2 years

* Start Date or Anticipated Start Date of Church Plant

* Will your church plant be linked to the current church you are attending?

Yes
No

* Name of Church Plant

* Suburb/s of current/prospective church plant

* State that your church plant is/will be based in

* Postcode of church plant

* Which Denomination/Movement will the church plant belong to?

If you selected ‘other’ please state denomination/movement name

Any additional details you would like to provide? Please note them below

* Choose a Password

must be 6 or more characters

* Confirm Your Password