APPLICATION FOR MEMBERSHIP

Application fee: $200.00

CHURCH NAME:  ________________________________________________

ADDRESS:  ______________________________________________________

CITY: ______________________ STATE: _________ ZIP CODE: _________

TELEPHONE: _________________ FAX NO. __________________________

FINANCIAL OFFICER’S NAME: ___________________________________

NUMBER OF MEMBERS: ___________ AUXILIARIES: ________________

IS THE CHURCH INCORPORATED: _________ YES __________ NO

IF NO, EXPLAIN __________________________________________________

IS THE CHURCH 501 © (3) TAX EXEMPT?  _________ YES _________ NO

IF NO, EXPLAIN __________________________________________________

PASTOR’S NAME: ______________________________________________________

SPOUSE NAME: ___________________________ NO. OF CHILDREN: __________

HOME PHONE: ___________________________ CELL: _______________________

EMAIL ADDRESS: ______________________________________________________

YEARS IN MINISTRY: ___________ YEAR ORDAINED: _________                                          

MINISTY MISSION STATEMENT: _____________________________________

__________________________________________________________________

_________________________________                  ______________________

Signature                                                                                   Date