P a g e
1 6
Cell Phone Number:__________________ Home Phone Number:_________________ Current Mailing Address:__________________________________________________ City/State/Zip Code:______________________________________________________ Name of Ministry or Church:________________________________________________ What is the size of your church or ministry membership?_________________________ What is the church or ministry website address?________________________________ Are you willing to support the national work with a support gift whenever possible from special events? Y/N__ Will your church or ministry support the Jurisdiction you are in with the tithing program? Y/N____________________ Are you a Bi-Vocational Pastor or Ministry Leader? Y/N______________________ Are you in full-time ministry? Y/N____________________ Would you like to become a ministry service provider for the network? Y/N___________ What is your email address:________________________________________________ Would you like to receive credentials and ordination from the network? Y/N__________ If yes what credentials and/or ordination would you like? ______________________________________________________________________ Have you ever been convicted of a felony? If so, please explain: ______________________________________________________________________ ______________________________________________________________________
LAST NAME_________________________________ FIRST NAME________________________________________