Back 2 Basics Application

Applicant's Name *

First Name

Last Name

Applicant Gender *

Male

Female

Applicant's Birthdate *

MM

DD

YYYY

Parent/Guardian Name *

First Name

Last Name

Parent/Guardian Gender *

Male

Female

Parent/Guardian Phone *

(###)

###

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Dates *

What dates are you interested in attending TMM's Back 2 Basics course?

June 16th -June 22nd

July 14th - July 20th

Senior pastor's Name *

First Name

Last Name

Senior Pastor's Phone *

Country

(###)

###

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How would you like to pay? *

PayPal through Donations Tab

Mail in Check

Call about a Credit Card