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T-JTA Workshop Request

(Submitting this form does not obligate you in any way to host a workshop.
It will help us in planning future workshops.)
The limited number of TJTA trainers usually dictates that workshops be conducted in larger metropolitan areas where more people can attend. This often requires many participants to drive some distance and arrange for food and lodging. We have decided to reverse this process, require fewer people be inconvenienced, and give more access to our workshops.

If you would like to have a workshop in your area please complete the following information.

Your personal information
Your Name :
address :
City : State :  Zip :
Country :
 Mail delivery code if outside United States :
Telephone with area code (country code outside United States)



Your Church or Organization information
Church or Organization
Name :

address :
City :  State :  Zip :
Country :
 Mail delivery code if outside United States :
Telephone with area code (country code outside United States)


Your Denomination/Faith Group affiliation

OR
Other (please specify) :

Your present position or job title :

Are you currently serving in a church ? For how long ?

How did you hear about our workshops?

OR

Please use this area to tell us what dates you might want a workshop and how many people you know who might be interested in attending  ?   ?

  
If this direct form does not function for any reason
Please immediately notify us via our direct email at counslor@yahoo.com

Or send by mail to :
COUNSELSOURCE
TJTA Workshop
P.O. Box 64421
Virginia Beach, VA 23467-4421
United States

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