Gwen Shamblin 's Weigh Down Diet: 2003 On-line Survey


	The Last EXODUS Coordinator Application DATA and QUESTIONS

Thank you for your interest in coordinating ‘The Last EXODUS’! This seminar already has produced amazing testimonies even in its initial PILOT stages, and we’re excited that you want to help young people give their lives COMPLETELY over to God! This is the most powerful seminar for children on the market for permanent weight loss and drug problems. NOW is the time to do this! Initially, we are looking at offering one class per city or town, depending upon demand. So get your application in as soon as possible, and we will call you soon! Please take a moment to complete the following application and press the ‘Submit’ button at the bottom of this page when you’ve completed the form. You may also opt to print this application and fax it to The Weigh Down Workshop, Inc. That fax number is 1-615-771-1165, or you may fax the form to us toll free at 1-800-340-2142. Thank you, in advance, for your interest in changing the course of the lives of countless young people!

Please tell us who you are... (This is primarily to prevent duplicate application entries.)

General Information
Email Address
First_Name
Last_Name
Street
Apartment
City
State/Province	(if International, choose "other")
Zip/Postal Code
Country
Home_Phone
Day_Phone
Denomination
Gender	Male Female

Date of Birth

Month

Day

Year

(in 250 characters or less) Give us a brief history of your experience in Teaching Children, if any?

(in 250 characters or less) Tell us the main reasons you would be interested in coordinating seminars for The Last Exodus Seminar Series?
ENter your reasons here...

Other Rebuilding the Wall Tour event