Facilitator Activation


                

                        If you would like to be activated as Facilitators of a 2=1 video course, please complete and submit the following information. Thank you!
Items with an * are required.
Date
                            
                            Date Format: MM slash DD slash YYYY
                        
                        
Husband's First Name*
                            
                            
                                                    First
                                                    
                                                
                            
                            
                            
                        
Wife's First Name*
                            
                            
                                                    First
                                                    
                                                
                            
                            
                            
                        
Your Last Name*
                            
                            
                            
                            
                                                            Last
                                                            
                                                        
                            
                        
Have you been trained as a 2=1 Coaching Couple?*Yes
No
Husband Age*Please select your age group
Husband Times Married*How many times have you been married?
Wife Age*Please select your age group
Wife Times Married*How many times have you been married?
Wedding Date*
Address*    
                    
                         
                                        Street Address
                                        
                                    
                                        Address Line 2
                                        
                                    
                                    City
                                    
                                 
                                        State / Province / Region
                                        
                                      
                                    ZIP / Postal Code
                                    
                                
                                        Country
                                        
                                    
                    
                
Email*Please enter a contact email

                            
                        
Contact Phone*
Please Choose:*We never sell or give out your information but we do use contact email to send notices, updates, and newsletters. Please indicate if you give permission for us to contact you this way.

								
								Yes - 2=1 may use these contact details so we can be contacted by email (or other methods) with updates and invites to future courses/conferences and other events. We understand that 2=1 will not share our details with anyone else.
							

								
								No - 2=1 may not use these contact details so we can be contacted by email (or other methods) with updates and invites to future courses/conferences and other events. We understand that 2=1 will not share our details with anyone else.
							
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