HOSTCHURCH APPLICATION FORM
Due Date: January 15, 2013
Return this form and the $149 application fee to:
Tidal Impact c/o Mrs. Jacqueline Derrah
Convention of Atlantic Baptist Churches
1655 Manawagonish Road, Saint John, NB E2M 3Y2
(Make cheques payable to “Tidal Impact”)
Church Name: ______
Address:______
City/Town: ______Prov: ______Postal Code: ______
Pastor’s Name: ______
Email: ______Phone: ______
For future correspondence related to this event please provide us with the following:
Mission Team Leader’s Name: ______
Email: ______Phone: ______Cell: ______
How many teens do you think will be part of your Tidal Impact team? ______
How many leaders? ______
Would you like the Tidal Impact registrar to assist you in finding a visiting church? YES ______NO ______
If not, what church will you be partnering with? ______
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OVER – Please see other side
PRAYER PARTNER
We have been approached by the Atlantic Baptist Women (ABW)about the opportunity to partner participating churches with one of the ABW members as a prayer partner for this event. This individual will be committed to pray for your team and ministry experience as you prepare and then participate in the week of ministry. They will be available to receive specific prayer requests from you both leading up to the week and as your week of ministry unfolds. The TI Executive is excited to have this group of women upholding 1000 people and their respective churches in prayer and praying over the entire week of ministry.
Would you like to be partnered with an ABW representative for prayer support as you prepare for an participate in your week at Tidal Impact?
Yes ______No thanks ______
Tidal Impact (TI) is flexible and unique to meet the needs for your church and youth to help them grow and be stretched in their faith. Past experiences have included anything from children’s ministry to prison ministry. If you’d like assistance in planning your morning ministry please contact: Jacqueline Derrah(506-635-1922 ext. 101) or .
We have a brand new book available to you (at no cost). Building Young Leaders: Using Mission Experiences To Help Grow Youth As Leaders, written by Mike McDonald and Bruce Fawcett, provides a step by step plan to prepare your group. If you have not already received your copy and would like one please check here: ______
If you have any questions about finding a visiting church, preparing your team, or planning for the event please contact Jacqueline Derrah at 506.635.1922 ext. 115 or .
You can register your church by completing this form and returning it to Jacqueline Derrah or you can register online (after Nov. 15) at with your Visa or Master Card.