October 2022 Reaching the Unchurched Immersion Excursion Application

Please fill out the application below to be considered for the October 6 - 9, 2022, Reaching The Unchurched Immersion Excursion to Hot Springs, Arkansas. The biography information will be shared with others attending the Immersion Excursion. All other information will remain personal and confidential and viewed only by Church Doctor Ministries staff. If you have any questions or have any trouble with this form, please call Nicki, 1.800.626.8515, or e-mail her at nicki@churchdoctor.org. You will be contacted about how to pay online.
  • MM slash DD slash YYYY
    1 = lowest, 10 = highest
    1 = lowest, 10 = highest
  • Special requirement could include a special plug for a CPAP machine.
  • Accepted file types: jpg, png, Max. file size: 64 MB.
    Please email a profile picture to Nicki Tackett at nicki@churchdoctor.org if you don't have it available now or have difficulty attaching it to this form.

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