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"RESET" - CONVERGE 2019
Registration Form
Name/Nom *
Your answer
Which location will you attend? À quel endroit allez-vous vous rendre ? *
Phone or GSM:
Your answer
Email: *
Your answer
Home Address:
Your answer
Nationality:
Your answer
Emergency Contact Name & Phone Number: *
Your answer
Belgian ID# : *
(Please include expiration date/Veuillez inclure la date d'expiration)
Your answer
Passport # : *
(Please include expiration date)
Your answer
Age: *
(as of August 1, 2019)
Your answer
Gender: *
Language Preference for devotional book *
Please list any allergies or dietary restrictions you have.
Your answer
Please list any medications you take regularly and what they are for
Your answer
If you have an abonnement for MVIB, LIJN or the Train, please indicate what applies (only applies for those living in Belgium):
Please indicate your gifts and talents by choosing one or more areas you are interested in:
This will allow us to place you in the proper ministry team.
Music: what instrument(s) do you play and for how long?
Your answer
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