Contact Moosejaw

Legal First Name*

Legal Last Name*

Preferred Name (if applicable)

Date of Birth*

Citizenship*

Gender* Male
Female

Marital Status* Single
Married
Separated
Divorced

Address*

City*

Province*

Postal Code*

Phone*

Type* Cell
Home
Work

Email*

What High School did you graduate from?*

Province*

Year of Graduation*

Do you have any post-secondary education? If so, please list below.

When did you get born again?*

How does your faith impact your everyday decisions and activities?*

Why are you interested in participating in this program?*

What church are you presently attending, and how long have you been going there?*

What is the name and contact information of your pastor?*

Which ministry or programs are you currently involved in at your church and in what capacity?*

We are able to offer all 10 courses for $100.00/course. These fees can be paid all at once up-front or in 4 separate instalments over the year.

Is the cost of this program going to be a financial challenge for you?* Yes
No

If you have any questions about the Victory Leadership Program please contact us at:
Email: leadership@vccfasttrack.ca
Phone: +1 (403) 286-8337

Please Note: A pastoral reference form will be sent to your pastor for him to complete and send back to us.

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Thank you for filling in this Registration Page information.

Our facilitator at the Moosejaw location will contact you shortly.

God Bless and have a wonderful day!