See A Man Be A Man (SAMBAM)
 
  Mentoring program of Board of Men's Ministries;
Church of Christ of the Apostolic Faith;
Jesse L. Gamble, Mentoring Program Chairman;
Ernest Walker, Director/Chairman;
District Elder Eugene Lundy, M.D., M.B.A., D.D., Pastor
 
   
:: Student Registration Form ::
 
   
*Click Here for the mailable, printer-friendly version  
(Requires Adobe Acrobat Reader)

 
   
Name:  
   
Address:  
   
City:  
   

State:

 
     
Zipcode:  
   
Phone Number:  
     
Last Grade Completed:  
     
Date of Birth:  
   
Emergency Contact Name:
 
     
Emergency Contact Phone:  
     
Short Term Goals:  
     
Long Term Goals:  
     
Hobbies:  
     
Clubs and /or organization in which you participate:  
     
Reference:  
     
     
:: Parent Authorization ::
     
Parent Name:  
     
Date of Authorization:  
     
Home telephone number:  
     
Business telephone number:   Ext:
     
     
 
 
   
   
 
 
   
   
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