2018 New Member Credentials Payment Form

River Credentials are based upon a full calendar year of being credentialed beginning Jan. through Dec. Members are responsible to renew each December. The River offers monthly payments as a ‘convenience’ option.

Yearly Credentialing Dues:

$405 for individual rate

$540 for couple rate

Amounts for MONTHLY DUES ARE PROATED and WITHDRAWN QUARTERLY upon sign up. Monthly Payments thereafter will continue as normal based on individual or couple rate.

Full Name *

First Name Last Name

Ministry Title *

Cell Phone *

Area Code Phone Number

E-mail *

Spouse Name (if applicable)

First Name Last Name

Spouse Ministry Title (if applicable)

Spouse Cell Phone Number

Area Code Phone Number

Spouse Email

Address *

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code Country

Please Let us know which personal contact info you would like listed in The River directory. Please use my:

Church Address Home Address

Church Phone Cell Phone

Church Email Personal Email

Home Church / Ministry Associated with

Ministry Address

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code Country

Ministry Phone

Area Code Phone Number

Ministry Email

Ministry Website

Paying for Individual or Couple? *

Payments taken out on the 5th or 20th each month? *

Making payments using... *

Name of Business/Ministry:

Please use the area below to fill out your credit card information. Please use correct credit card billing information as many business/ministry credit card have different billing addresses than home address. Thank you.

Payment Options *

Individual Rate for members joining in May ( $ 39.00 for each month )

$78 for the first month then $39 per month for the rest of the year

Couple Rate for members joining in May ( $ 49.25 for each month )

$98.50 for the first month then $49.25 per month for the rest of the year

Credit Card
First Name	Last Name
Credit Card Number	Security Code
Expiration Month	Expiration Year
Billing Address
Street Address
Street Address Line 2
City	State / Province
Postal / Zip Code	Country