First Given Name

Family Surname

Church Name

Denomination

City

Country

WhatsApp ID

Email Address

Office/Title Office/Title Apostle Bishop Pastor Evangelist Prophet Teacher

Do you lead a pastor’s network? Do you lead a pastor’s network? Yes No

Name of Network

How many pastors?

How many members in your congregation? How many members in your congregation? 1–250 250–500 500–1000 Over 1000

Have you ever attended a Go Deep Grace Conference? Have you ever attended a Go Deep Grace Conference? Yes No

City

Nation

Date