Lead Registration

Applicant Information

Title

Name

Date of Birth

Phone Number

Cell Phone Number

Work Phone Number

Spouse Information (if applicable)

Spouse Name (if applicable)

Spouse Date of Birth (if applicable)

Spouse Email (if applicable)

Spouse Cell Phone Number (if applicable)

Spouse Work Phone Number (if applicable)

Anniversary Date (if applicable)

Home Address

Address

Work Information

Employer

Your Professional Title

Work Address

Spouse's Employer (if applicable)

Spouse's Professional Title (if applicable)

Spouse's Work Address (if applicable)

Open Ended Questions

What do you hope to gain from LEAD?

How did you hear about LEAD?

Costs

A $500 deposit is due before your application will be accepted. (Refundable up to 4 months before your requested LEAD date). The remaining balance will be due 2 months prior to your specific LEAD date. (This fee is non-refundable).

Which LEAD date would you prefer to attend?

You may choose to pay the full amount for LEAD today, or you can go ahead and make a deposit of $500 and pay the rest at a later date.

Amount

Suggested Amounts

$500
Other Amount

If you choose the mail-in payment option, please mail your payment to:

Dallas Theological Seminary
Attention: The Hendricks Center
3909 Swiss Avenue
Dallas, TX 75204

Checks should be made out to: Dallas Theological Seminary

Total

$0.00

Billing Information

Name

Payment Method

Credit Card
Check
Mail-in Check

Credit Card

Visa
Mastercard
American Express
Discover

Address

Phone Number

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