Master Guide-Insignias Request Form

Master Guide-Insignias Request Form

Hoja de Pedido de Insignias para Guías Mayores
Gulf States Conference of Seventh-day Adventist
YOUTH MINISTRIES DEPT.
P.O. Box 240249, Montgomery, AL 36124
Phone: (334) 272-7493, ext. 123 Email to:erodriguez@gscsda.org
Name

First NameMiddle InitialLast Name
Address:

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Date of Birth:

MonthDayYear
Date
Age: (please circle one)
Cell Number
Please enter a valid phone number.Format: (000) 000-0000.
Type a question
Email Address:
example@example.com
Please make sure your email address is legible
Master Guide Program Start Date

MonthDayYear
Date
Completion Date

MonthDayYear
Date
Please Provide for following Review
Area Coordinator ONLY: Please specify if the MG Star or a Star with the Class Chevrons
Area Coordinators Only- Candidate is a registered MG of the YMMS Systen under the GSC - Invested date
Candidate has been approved for Recertification - Re-certification Date
For Area Coordinators Only
Area Coordinator Signature
Date Request is Send/Emailed
FOR GSC YOUTH MINISTRIES OFFICE USE ONLY
Youth Department Secretary ONLY
Date Received:

MonthDayYear
Date
Date Approved:

MonthDayYear
Date
Signature:
Should be Empty: