Church Group Registration Form 149

Church Group Registration

Thank you for your interest in registering members of your church staff for PastorWell. Complete the form below to begin your registration process.

Group Administrator Contact Information
Name
First Last
Email
Phone
Church Name
Member Registration Information
Please complete the following information for each new PastorWell Member. To add another row, click the plus (+) icon.
First Name Last Name Email Mobile Position
Payment Details
How would you prefer to pay for these registrations?
- Credit Card
- Send Me An Invoice
Enter the quantity of members listed above.
Price: $149.00 Quantity:
Total
$0.00
Credit Card

Card Details

Cardholder Name
Card Billing Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Is this address the same as the church address?
- Yes
- No
Church Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

First Name	Last Name	Email	Mobile	Position