Lazarus Weekend Online Application

Your name

Your Address

Your Age

Your email

Your Mobile Phone

Your Marital Status
MarriedSingleWidowedDivorcedSeparated

Name of Your Home Church

Home Church City and State

Name of Your Pastor

Your Pastor's Phone Number

What Lazarus Weekend are you applying for?
WinterSummer

Why do you want to participate in a Lazarus Weekend?

Do you have any food allergies?

Do you have any special needs we should be aware of in order to better host you?

Where do you prefer to stay while attending the weekend?
My Home/Family/Friends near SelmaA Hotel in SelmaA Host home

How will you be paying your $150 fee? We cannot reserve your place until we receive both the application and fee.
Check mailed to AslanRoarsOnline

Additional information (optional)