Ukraine, March 2012
To continue to the application form, please enter your initials below. By doing this you signify that you have read and agree to the material on this page. *
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I understand that by registering to attend a Come before Winter renewal that I am releasing pictures of myself (taken during the event, both still camera shots and video footage) for Come before Winter to use to in ministry reports, fundraising efforts, or any published or printed materials required to support the ministry. *
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First Name *
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Last Name *
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Name as you would like it to appear on name tag *
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Email Address *
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Mailing Address *
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Mailing Address 2
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City *
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State *
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ZIP *
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Phone Number #1 *
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Phone Number #2
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Birthdate (mm/dd/yyyy) *
Ex: 11/01/1972
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Spouse's name *
if applicable - if not, write "None"
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Children's names and ages *
if applicable - if not, write "None"
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I will be bringing my nursing infant to the renewal *
Nursing infants under one year of age are welcome
City and country in which you serve *
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Complete name of sponsoring congregation *
please give us the mailing address, website, or telephone number
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Full name of the congregation with which you now worship *
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Please list any health problems, including any recommendations for assisting you with these problems *
(Accurate medical information, including chronic or acute illnesses and all medications MUST BE DISCLOSED. Information will be kept confidential. This is extremely important. Failing to disclose such information will be considered a breach of confidence.)
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Please list all medications you take regularly *
(Accurate medical information, including chronic or acute illnesses and all medications MUST BE DISCLOSED. Information will be kept confidential. This is extremely important. Failing to disclose such information will be considered a breach of confidence.)
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Please list any dietary restrictions *
(Accurate medical information, including chronic or acute illnesses and all medications MUST BE DISCLOSED. Information will be kept confidential. This is extremely important. Failing to disclose such information will be considered a breach of confidence.)
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Emergency Contact Person *
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Phone number for emergency contact person *
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We want to put a face with your name as soon as possible. If your picture is posted on a website, please give us the web address to view these pictures.
(optional)
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Attendance in previous CbW renewals *
If you answered YES to the above question, indicate which renewal(s)
(only required if you answered "Yes" to the above question)
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Roommate Preference *
If you have a preference, please list her/their name(s) below
(only required if you answered "Yes" to the above question)
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I/my group plan(s) to arrive in Dzherelo sanitorium, Kiev, on (enter date) *
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...at about (time) *
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...by (mode of transportation) *
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If you are arriving before March 12, please let us know where you will be staying and how we might get in touch with you.
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How and when did you come to know the Lord? *
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Tell us about the formative experiences and/or formal training that prepared you for ministry. *
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Years in ministry or service *
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Describe your primary ministry at this time *
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Share with us a psalm (or other scripture) that has repeatedly blessed your life *
(Please include the book, chapter, and verse)
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I regularly gain spiritual energy from:
(rank ONLY YOUR TOP 5 with 1 being the practice you engage most often. You should only have 5 choices selected as your Top 5)
1 (most often)
2
3
4
5 (least often)
Solitary Prayer
Group Prayer
Corporate Worship
Devotional Reading
In-depth Bible Study
Periods of silence and reflection
Service
Seminars/retreats/conferences
Friends
Other (see below)
If selected Other, please specify practice
(optional)
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List three gifts of grace (unexpected or undeserved blessings) that repeatedly bless your life *
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List three stressors that repeatedly complicate your life and describe how you usually cope with them *
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On a scale of 1-10 (where 1 is “hardly noticeable” and 10 is “more than I can bear”), rate your stress level over the last 12 months. Explain your response with some detail *
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My deepest study has been inspired by *
When I sit down to study the Bible I primarily rely on these tools/aids of study
(Choose ONLY 3 and rank them with 1 being the tool you use the most. You should only have 3 choices selected and 5 options not selected)
1 (most use)
2
3 (least use)
Bible
Concorndance
Commentary(ies)
Bible encyclopedia(s) and/or dictionary(ies)
Devotional or inspirational book
Lexicons
Interlinear translation
Original language texts
What area(s) of our program do you expect to bless you the most?
(Choose ONLY 3 and rank them with 1 being the GREATEST ANTICIPATED BLESSING. You should only have 3 choices selected and 3 options not selected)
1
2
3
In-depth Bible study
Scheduled periods of silence and reflection
Prayer in small groups
One-on-one prayer time
Personal sharing
Staying on schedule
What area(s) of our program do you expect to challenge you the most?
(Choose ONLY 3 and rank them with 1 being the GREATEST ANTICIPATED CHALLENGE. You should only have 3 choices selected and 3 options not selected)
1
2
3
In-depth Bible study
Scheduled periods of silence and reflection
Prayer in small groups
One-on-one prayer time
Personal sharing
Staying on schedule
Tell us about something you read, a song you love, or a message you have heard in the last year that now has special meaning for you. Explain your answer. *
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If you could walk away from this renewal with one spiritual blessing, what would it be? *
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Given what you know about our program, what else might you share that would help us to better pray for your renewal experience and/or to walk alongside you at that time? *
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To complete your entry and ensure that you have read and understand the registration information on this application, enter your initials below *
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Enter today's date (mm/dd/yyyy) *
(Then click the Submit button below to complete the application process)
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