Name of Discipleship Applicant *

First Name

Last Name

Address *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Telephone Number *

(###)

###

####

Have you accepted Jesus Christ as your Savior? *

Yes

No

How long have you been a Christian? *

1-3 years

5-10 years

10 years (+)

Are you a member of Oasis? *

Yes

No