*Name:
Address:
City/State/Zip:
Day Telephone:
*Night Telephone:
*e-mail:
*I am interested in:	Disciple I                   Disciple II             Disciple III       Disciple IV       Christian  Believer
*The best times for  me to attend are: (check all possibilities)	Sunday      Monday       Tuesday      Wednesday  Thursday        Friday      Saturday    Morning           Afternoon           Evening
Comments:
	* Indicates information is required.