Training Registration Form
Name:
Address:
City:
 State Zip
 
Phone (Home):
Phone (Work):
Phone (Mobile):
Email:
Gender:


(If requesting lodging for courses offered at MERCI)
District:
Church:
 
Preferred Session:


Comments:

 

 

 

Feel free to email us at:

bgross@windstream.net



You can also reach us by
US mail at:

UMVIM, NC
1910 Wedgewood Drive
Sanford, NC 27332

or give us a call at
(919) 498-1660.