CHURCH PLANTING INTEREST FORM

First Name

Last Name

Email Address

Phone Number

Where are you requesting WCI to plant a church?

Country

How many Winners members do you know currently live within the location you are requesting?

Do you have a physical location in mind? Yes / No

Yes

If yes, what is the location physical address and what is the size of its occupancy?

How soon would you be ready for takeoff of the Church in your desired location (If possible state anticipated date)

Are you available as a steward to be engaged at the initial stage?

Yes