The Salt & Light Brigade Registration Form
Please only provide information that you are comfortable sharing! The more info we have, the better your talents and skills can be utilized. Please check your email to confirm registration. Thank you!
*
indicates required
Name:
Email:
Comment:
Email Address
*
First Name
*
Last Name
Street | PO Box
City
State
*
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
Washington D.C.
West Virginia
Wisconsin
Wyoming
Not a U.S. Resident
U.S. State (Choose Not a U.S. Resident if outside the U.S.)
Zip Code
This helps us alert you to local events.
Gender (M or F?)
*
Male or Female?
Phone Number
(
)
-
NOTES:
Veteran?
Yes
No
I can attend a Boot Camp?
Yes
No
I can help mobilize for regional deployment event:
Yes
No
I can attend a regional or national event:
Yes
No
I can coordinate dorm style lodging for an event:
Yes
No
I can help coordinate a boot camp:
Yes
No
I can coordinate a local speaking event for Coach:
Yes
No
I can support through social media sharing:
Yes
No
I can offer graphic design or promotion resources:
Yes
No
I can provide financial support:
Yes
No
I can help with Prayer & Intersession:
Yes
No
I watch Coach's show almost daily:
Yes
No
I watch Coach's show 1-2 times/week:
Yes
No
I watch Coach's show a few times per month:
Yes
No
I found Coach through a friend:
Yes
No
I found Coach at CoachDaveLive.com:
Yes
No
I found Coach at a Hear the Watchmen event:
Yes
No
I found Coach on Hagmann Report:
Yes
No
I found Coach on Social Media (youtube,etc):
Yes
No
I found Coach on Patreon.com/coachdavelive:
Yes
No
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