African American Church Evangelism Institute Interest Form

First Name

Last Name

Phone

Phone Type

Church Name

Church Address

City

State/Province

Zip

Church Denomination (if applicable)

What is your role at your church?

Please let us know any specific questions you may have.

How did you hear about the African American Church Evangelism Institute?

Please let us know any specific questions you maybe have.

Is there anyone in your network that you think would be interested in this program? If so, please provide their contact information.

I agree to submit

Yes
No

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