LIV4Change Application Form
Please fill in the form below to apply for a place on the LIV4Change Discipleship School. You will be requested to attach a copy of your ID/Passport & Police Clearance/DBS. If you do not currently have a Police Clearance/DBS, please apply for one and send it through to l4cadmin@liv-village.com when you receive it.
Personal Details
Full Name: *
Address: *
Telephone Number - Home: *
Telephone Number - Mobile: *
Email: *
Skype Name: *
Date of Birth: *
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Age: *
Gender: *
Your Nationality: *
Passport Number: *
Date Issued: *
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Valid until: *
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Marital Status: *
In case of emergency, your contact person:
Name: *
Telephone number: *
Email Address: *
Home Address: *
Relationship to you: *
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