Name *

First Name

Last Name

Address *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Phone *

(###)

###

####

Receive text reminders? *

Yes

No

Social media

Check all that apply

Facebook

Instagram

Area of Interest *

Check all that apply

Audio

Video

Lyrics

Lighting

Photography

Social Media

Other

If the above person is a Lighthouse Ministry Leader, does this leader know you're interested in joining the Media Ministry?

Yes

No

Do you feel the Media Ministry is your primary or secondary area of ministry?

Primary

Secondary

Availability *

Check All That Apply

1st Wednesday

2nd Wednesday

3rd Wednesday

4th Wednesday

5th Wednesday

Salvation through Jesus Christ? *

Yes

No

Water baptism? *

Yes

No

Spirit baptism? *

With evidence of speaking in tongues?

Yes

No