First Name(s) *

Surname *

Contact Numbers *

Email *

Date *

Do you belong to a winners Satellite Fellowship Centre? *

If no, can we contact you with details of the nearest WSF centre?

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If no, please tick to choose your preferred service unit *

By completing this form, you agree that WMA-WCI will use, process and retain your personal data in accordance with our Privacy Policy. You have the right to withdraw this consent at any time. Please refer to our privacy policy on our website for further details on how we use your data and how to withdraw your consent: https://www.winners-chapel.org.uk/privacy-policy.