Organizations Application – Synergy Training Solutions

Organization Application

Organization Name *

Pastor Name (if applicable)

Contact Person *

Address *

City *

State/Province *

ZIP / Postal Code *

Country *

Cell Phone *

Home Phone

Email Address #1 *

Email Address #2

Team Leader Name *

Start Date *

Month *

Day *

Year *

End Date

Month

Day

Year

Credit / Debit Card *

Donations

USD

Please return completed participant application to the Lead and Read Program: r mail it to Synergy Training Solutions, Lead and Read Program, 109 N. Graham Street, Suite 106, Chapel Hill, NC 27516. If you have any questions, please contact us by email: info@synergytrainingsolutions.org or at the numbers listed below,