Name *

First Name

Last Name

Phone

(###)

###

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Birthdate

MM

DD

YYYY

Business Phone *

(###)

###

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Business Address *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

What are you most interested in gaining from this group? *

(Select all that apply)

Spiritual growth

Business skills and strategies

Networking opportunities

Family enrichment

Personal mentorship

Support and encouragement

Membership Commitments *

Please read and confirm your agreement to the following:

I commit to regular attendance at 75% of the scheduled meetings.

I affirm Avodah’s statement of principles.

I agree to adhere to the Avodah code of ethics.

I declare my Christian faith by affirming the Apostles Creed.