Qualified Peer Coordinator (QPC)Site Registration FormFill out the form below and we will be in touch! Name * First Name Last Name Address Address 1 Address 2 City State/Province Zip/Postal Code Country Phone (###) ### #### Email * Affiliated Site Information * Indicate in the box below the Christian Community Church and contact information for the Executive/Lead Pastor through which you plan to coordinate the Apostles of Life Program. Authorization to Contact Site Do you authorize the Director at Apostles of Life to contact the person identified as the Executive/Lead Pastor at the proposed Site for the purposes of confirming Site Eligibility? Yes, for the purposes of Site Verification, the Director of Apostles of Life may contact the Executive/Lead Pastor at the Site I have indicated. No, I do not give permission for the Director of Apostles of Life to contact the proposed Site for verification purposes. I would prefer to hold on Site Verification contact at this time but am aligned with future Site verification. Thank you for your Site Registration request. For additional information, please contact director@apostlesoflife.org
