Discipleship Deliverance Class Enrollment
October 2020 Classes
First Name *
Last Name *
Your Preferred Email Address *
Your Address *
Your Primary Contact Phone Number *
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Will a spouse attend with you? *
If "yes," what is your spouse's FIRST name? (Enter n/a if a spouse will not be attending.) *
If "yes," what is your spouse's LAST name? (Enter n/a if a spouse will not be attending.) *
If "yes," what is your spouse's EMAIL ADDRESS? (Enter n/a if a spouse will not be attending.) *
How did you hear about Whole Catholic Coaching? *
What is the Name, City, and State of your home parish? (enter n/a if not applicable) *
PAYMENT *
If you chose "OTHER" on the Payment question, please indicate your payment arrangements here. Type "n/a" if this does not apply to you. *
If you chose "QUESTION" on the Payment question, please type your question here and let us know the best way to contact you (phone, email, etc) Type "n/a" if this does not apply to you. *
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