The Circle Application
TODAY'S DATE *
MM
/
DD
/
YYYY
DATE OF BIRTH *
MM
/
DD
/
YYYY
LAST NAME *
Your answer
FIRST NAME *
Your answer
SEX *
FULL ADDRESS *
Include City, State, ZIP, & County
Your answer
EMAIL *
Your answer
CELL PHONE # *
Your answer
HOME PHONE # *
Your answer
BECAUSE PARTICIPATION IN THE CIRCLE WILL HELP TO FUND “CHRIS ESTRADA MINISTRIES” VISION “TO RELEASE COURAGE AND POWER TO RISK TAKERS AND DREAMERS, WHO DESIRE DIVINE TURNAROUND,” ARE YOU ABLE TO COMMIT TO YOUR SELECTED TIER YEARLY DONATION AMOUNT (TO BE DONATED IN MONTHLY DONATIONS) TO CEM AS PREVIOUSLY STATED? *
WHICH CIRCLE TIER WOULD YOU LIKE TO JOIN AT? *
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