Ministers Information Form
(As you would like to appear in the Church Directory)
Ministers Contact Information

Please Complete form in full. All information gathered will be for the use of the District Office.

Section Number:
First Name:
Last Name:
Your Birth Date:
Social Security #:
Name of Spouse:
Spouse's Birth Date:
Marriage Date:
Address Street 1:
Address Street 2:
City:
Zip Code: (5 digits)
State:
Daytime Phone:
Evening Phone:
Email:
Name of the Pastor of the Church you attend:
Name of Church you attend:
Church Address:
City:
Zip Code:
State:
Church Mailing Address:
City:
Zip Code:
State:
If you have attended this Church for less than 2 years, please list all the names of the Pastors and Churches you have attended in your Christian Life:
  Local
 Type of license you hold:
 General

 Ordination
If you hold Ordination or Honorary Status and you are RETIRED, would you like your name and address to be listed in the Retired Minister's Section of the District Church Directory?:
Please select what applies to you:

I have been faithful to my Local Church in my
  Finances
  Moral Support
  Loyalty
  Attendance
Full Time Evangelists: Please select the appropriate:
Comments:



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