Please enable JavaScript in your browser to complete this form. Please enable JavaScript in your browser to complete this form. Name * First Last Preferred Name Gender Address Email * May we send messages to your email? * YES NO Phone / Cell Number * If exit past, May we send messages to your phone? * YES NO Reason for connecting with Desert Road Ministries (check all that apply): Individual Counseling Couples Counseling Neurofeedback Workshop / Presentation What type of ministry have you or your immediate family member(s) been involved in? (check all that apply) Church Ministry Parachurch Ministry Nonprofit Organization Other (specify): Ministry Specification What is the time frame for you or your immediate family member(s) involvement in ministry? Currently Serving Served in the Past No Longer Serving If you or your family member(s) served in the past, how many years? If no longer serving, what year did you or your family member(s) exit ministry? Submit
