First and Last Name (required)

Email (required)

Address (#, street, city, prov, postal)

Phone

Gender

MaleFemale

Birth Date (mm/dd/yy)

Church

Pastors name

Reference name & email (Officer or Yth Pastor or Leader)

School - current grade (age if graduated)

Present Acts of Heroism in Church and in Community (leading, helping, loving and serving others

What are you passionate about or like to do? (be specific, eg: DJ, hike, play guitar, teaching children...)

Deeper 1 - Tell us what God HAS done and IS doing in your life. (1/2 to 3/4 page minimum. Copy & paste from Word doc)

Deeper 2 - Tell us how you're wanting the X{LR}:8 experience to affect your life. (1 decent paragraph)

Choose an XLR:8 Location

BCON

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