Form

FIRST NAME*

LAST NAME*

EMAIL*

PHONE NUMBER*

STREET ADDRESS*

CITY*

STATE*

ZIP CODE

COUNTRY*

SCHOOL*

HS or COLLEGE?*

High School

College

GRADUATION YEAR*

WHAT LIFE CHURCH CAMPUS DO YOU ATTEND REGULARLY

EX. Life Church Yukon

TELL US WHY YOU WANT TO BE A STAY HERE AMBASSADOR*

(Min 100 words)