Home Group Leader Application Form

Today's Date *

MM

DD

YYYY

Name *

First Name

Last Name

Address *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Cell Phone *

(###)

###

####

Date of Birth *

MM

DD

YYYY

Wedding Date (If Applicable)

MM

DD

YYYY

Is your Spouse a Believer? *

Yes

No

Are you a Member of LPAG? *

Yes

No

Have you been Baptized in Water? *

Yes

No

Do you know your Spiritual Gifts? *

Yes

Not Yet

Are you currently in a Home Group? *

Yes

No

No, but I am interested in joining a Home Group

Have you filled out an LPAG Background Check? *

Yes

No

Do you affirm that the information in this application is correct to the best of your knowledge, and you give permission to LaPorte Assembly to verify this information. *

Yes

No