Preferred Level of Connection *

Please select only one.

Affiliation**

Christian Workers Certificate

Licensed Minister

Ordination

Name *

First Name

Last Name

Sex *

Male

Female

Address *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Mobile Phone *

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Work Phone

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Spouse's Name

First Name

Last Name

Are you a high school graduate? *

Yes

No

Do you have an undergraduate degree? *

Yes

No

Did you attend a bible school or seminary? *

Yes

No

What is your ministry involvement? *

Volunteer

Part-time

Full-time

Electronic Signature *

By typing your name, you are agreeing to the above statement.

First Name

Last Name

Date *

MM

DD

YYYY