Date Registered
*
CHURCH INFORMATION:
Organization Church Name
*
Pastor's Name
*
Please Check Appropriate Box
*
Pastor ($100.00)
Assistant Pastor ($50.00)
Associate Minister ($50.00)
Pastor's First Name
*
Pastor's Last Name
*
Asst. Pastor's First Name (if applicable)
Asst. Pastor's Last Name (if applicable)
Assoc. Pastor's First Name (if applicable)
Assoc. Pastor's Last Name (if applicable)
Church Address
*
Church City
*
Church State
*
Phone (Preferably Text Enabled)
*
Church Email Address
*
INDIVIDUAL INFORMATION
Individual Full Name
Individual Email Address
Individual Phone (Preferably Text Enabled)
Individual Address
Individual City
Individual Postal Code
Individual State