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 Prisons 
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Alpha for Prisons Course Registration


To help ensure our connections and assistance to effectively helping you start and run the Alpha Course in the prisons, jails, juvenile centers, etc., please complete and submit this form to the Alpha for Prisons office manager, Lou Ronna Richardson • louronnarichardson@alphausa.org

Please fill out the form below to register your Prison Course so we can better serve you:

 
Facility Name :
Facility Address:
Facility City:
Facility State:
Facility Zip code:
Prison Chaplain
Phone Number:
Email Address:
   
Alpha Leader Name & Title:
Leader Address:
Leader City
Leader State
Leader Zip
Leader Email
   
Organization/Church sponsor?          Organization or Church Name:
Church Address:
Church City:
Church State:
Church Zip:
Church Website:
Church Email:
Church Phone:
Pastor or Church Contact:
   
Date started Alpha course in facility
Are you using: DVD/Videos? Yes   No
Are you using Speakers? Yes   No
Do you have posters to advertise? Yes   No
Who is leading the Course?(e.g. Chaplain, Leader, Volunteer, etc)
How much time allowed for a session?
How many attended the course?
Are you able split into groups for discussion? Yes   No
If Yes, how many groups?
Do you have a prayer team to pray for you/team? Yes   No
How many regular volunteers on the team?

If you have questions, please contact Lou Ronna Richardson louronnarichardson@alphausa.org * 314 607-8850 or 800-215-9601

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