Alumni Association Application
First Name
Last Name
Email
Phone
Gender
Male
Female
Birthdate
Last 4 of SSN
How long have you been a Home of Grace alumnus?
Please select...
Less than 1 year
1 year
2 years
3 years
4 years
5 years
More than 5 years
Street Address
City
State
Please select...
AL
AK
AZ
AR
CA
CO
CT
DE
DC
FL
GA
HI
ID
IL
IN
IA
KS
KY
LA
ME
MD
MA
MI
MN
MS
MO
MT
NE
NV
NH
NJ
NM
NY
NC
ND
OH
OK
OR
PA
RI
SC
SD
TN
TX
UT
VT
VA
WA
WV
WI
WY
Zip Code
Is this a temporary address? (e.g. transitional/halfway housing, college, etc)
Yes
No
Monthly Alumni Meetings
How far would you be willing to drive once every month?
Please select...
More than 1 hour
45 minutes to 1 hour
30 to 45 minutes
No more than 30 minutes
I am unable to drive
I am not interested in attending
If unable to attend in person, would you be interested in joining by web video (e.g. Skype)?
Yes
No
Not sure
How much would you be willing to contribute ANNUALLY for membership dues if they provided additional resources and materials to association members?
$50 or more per year
$40 to $49 per year
$30 to $39 per year
$20 to $29 per year
$10 to $19 per year
Up to $9 per year
I would not pay anything
What would you expect to receive in return for membership dues?
Are you interested in being an alumni leader by taking additional responsibilities each month?
Yes
No
Maybe later
What are some of your gift sets or skills?
Event organizing and planning
Communications
Music / worship leading
Certified counseling
Other
Please describe your other skills
I consent to sharing my name, phone number and email address with Home of Grace appointed leaders in my area.
I agree
Contact Information
Need help?
Call (228) 826-5283 or
email us
.
Privacy Policy