Disciple-maker Registration Form

Today’s Date

(Use format: MM/DD/YY.)

Disciple-maker's Name

First

Last

What name does the disciple-maker prefer to be called?

Age

Disciple-maker's Phone Number

(If he has no phone number, leave blank.)

Disciple-maker's Email Address

(If he has no email address, leave blank.)

Disciple-maker's Country

Disciple-maker's City or Town

Disciple-maker's Church Name and Pastor Name

Are you registering as a Paul (18-29 years old) or Barnabas (30 years or older)?

Disciple-maker, how many young men will you disciple?

WHO WILL YOU DISCIPLE? List below the young men you will disciple. They must be AGE 18-29 and you can list up to a maximum of SIX young men. Write their first and last names, ages, and stage of faith.

Remember: 1. Eutychus – Discover. (Not committed to Jesus as Lord and Savior.) 2. Timothy – Learn and Belong. (Newly committed to Jesus.) 3. Titus – Work for God. (Committed for years and is serving in the church.) 4. Silas – Focus Inward. (Served for years and now training to make disciples.) 5. Paul – Focus Outward. (Committed to making disciples.) You must be a Barnabas to disciple a Paul, and that Paul must be registered.

In 200 words or less, describe your faith journey. (optional)

In 200 words or less, describe your desire to disciple young men. (optional)

Disciple-maker, by checking the below box, you acknowledge that Jesus is your Lord and Savior and that you are committed to being an excellent disciple-maker of young men.

Yes, I acknowledge and am committed.

Disciple-maker, by clicking the below box, you acknowledge that you read and understand the Disciple-Makers website page describing what it means to be a Network 20 disciple-maker.

Yes, I read and understand.

Disciple-maker, by clicking the below box, you acknowledge that you read, understand, and agree with our Statement of Faith and Core Values on the About Page.

Yes, I read, understand, and agree.

What is the first and last name of the person who completed this form?

First

Last

What is the email address of the person who completed this form?