First and Last Name *

Spouse's Name (if applicable)

Email Address *

Phone Number *

Home Address *

Which scholarship would you like to apply for? (You can select both options if you like.) *
All-Expense Paid Scholarship Free Registration Scholarship

Are you currently serving in ministry full-time? *
Yes No

How many years have you served in ministry? *

Have you attended the Refresh Conference previously? *
Yes No

If so, how many years have you attended the Refresh Conference? *

Name of Your Church/Ministry *

Ministry City and State *

What is your role/job title in your ministry? *

What is the approximate size of your ministry (in terms of people)? *

Does your ministry allot money in the budget for you to attend a conference annually? *
Yes No

If so, how much does your ministry allot?

Using the scale below, please rate your level of weariness in the ministry currently (1-10) *
— Select — 1 (Ready to Quit) 2 3 4 5 6 7 8 9 10 (Fully Energized)

How do you anticipate this conference aiding you and your ministry? *

Is there any other information you would like to share? *