Name *

First Name

Last Name

Address *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Phone *

(###)

###

####

What is your spouse's name? *

First Name

Last Name

Have you been born again? *

Yes

No

Have you been baptized in water by immersion? *

Yes

No

Have you received the baptism in the Holy Spirit with the initial physical evidence of tongues? *

Yes

No

Do you sense a call to ministry and can you articulate it? *

Yes

No

Do you currently hold Ministry Credentials with any other organization? *

Yes

No

Are you married? *

Yes

No

Do you or your spouse have a former spouse still living? *

Yes

No

Have you declared bankruptcy? *

Yes

No

Do you have any felony or misdemeanor charges on your record? *

Yes

No

Will you consent to full background, credit and reference checks? *

Yes

No