Rockbridge Alliance
Affiliate Application
About You
First Name *
Last Name *
Phone number
Email* (Please use the same email you submitted on the previous page).
Tell us a bit about your faith journey!
Where do you attend church?
What is your church's website?
About Your Business
Your Business/Brand Name*
Your Website (if you have one)
Job Title*
Select Your Industry*
Select One
Coaching
Legal/Law
Marketing
Other
If "other" please type-in your industry.
Your Credentials
Do federal, state, or local laws require you to be licensed, certified, and or insured to work in your job field?*
Yes
No
Please specify what the law requires. (List N/A if not applicable)*
Are you able to provide up-to-date verification for all industry-required credentials upon request?*
Yes
No
N/A
Please specify the credentials you have. (List N/A if not applicable) *
What training or education supports your current work?
How many years of experience do you have in your current or relevant positions?
Last Steps
How did you hear about us?
Select One
Church
Friend
Business
Social Media
Online Search
Other
Did someone refer you? Please list their name and email.
What country are you located in?
Select One
United States
Other
What time zone are you located in?
What makes you a great fit for the Rockbridge Founding Affiliate Membership?*
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