COPAH – Register: Voices for Justice

Please complete this form to confirm your participation.

Participant Information

Full Name

Gender

Male Female

Date of Birth

Nationality

Phone / WhatsApp

Email Address

Ministry / Organization

Church / Ministry Name

Role / Position

Region / City of Service

Years in Ministry

Participation Details

Will you need assistance with lodging?

Yes No

Will you need assistance with transportation?

Yes No

Special Needs / Dietary Restrictions

Commitment

By registering, I affirm my commitment to participate fully in "Voices for Justice: The Church Defending the Oppressed" and to uphold the spirit of unity, prayer, and advocacy for Haitian pastors and their congregations.

Signature

Date

Contact for Registration Inquiries:

COPAH Secretariat: copahhaiti@gmail.com / 305-478-1212

TIM Coordination: copahhaiti@gmail.com / 305-478-1212

VIM Coordination: copahhaiti@gmail.com / 305-478-1212