Church Planting

Interest Form

The information on this form will be sent to Converge MidAmerica Director of Church Planting Gary Rohrmayer.

Interest Form

First Name*

Last Name*

Middle Initial

Present Title (if applicable)

Present Organization (if applicable)

Your mailing address

City

State

Zip

Country (if not USA)

Work Phone

Home Phone

FAX

Email*

Personal/Organization web site

Your church planting experience

Additional comments (optional)

Thanks for your interest. Gary will contact you soon.