CLERGY REGISTRATION DATA COMMISSION
MEMBERSHIP APPLICATION
Full Name
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First Name
Last Name
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Date of Birth
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Month
-
Day
Year
Date
Phone Number
-
Area Code
Phone Number
TITLE
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E-mail
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How did you find out about CRDC?
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Please Select
Friend/Clergy
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Cook County Recorder
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Name of your Ministry or Church:
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What is your Apostle, Bishop, Pastor, etc; name?
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First Name
Last Name
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Church/Ministry
*
-
Area Code
Phone Number
Certificates or Licenses
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Apostle
Bishop
Pastor
Elder
Prophetess
Minister
Evangelist
Arch Bishop
Deacon
Deaconess
Missionary
Prelate Apostle, Arch Bishop
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Clergy Identification Card
$
40.00
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Total
$
0.00
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