ROOTED EXPIRIENCE REGISTRATION FOR 2024

First Name

This address will receive a confirmation email

Phone #

Address

Please check one:

Male Female

Do you want to be a member of ICC

Yes No

Are you doing Rooted with your Spouse?

Yes No

If Yes, please provide your Spouse First and Last Name below

Your Spouse must complete a seperate Rooted Registration Form

If you belong to a Life Transformation Group, please provide the name of your Leader

Please submit the completed form no later than April 15,2024.

Description

Please fill out this form and click submit.