New Member Credentials Payment Form - One time payment

Newly Credentialed Form (One-time Payment)
Once approved, use this form for Full Year upfront payment
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:
*

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
Making Payment with Personal or Business Credit Card? *
If using Business Card, type in Business/Ministry name

My Products *

Individual Rate Full Payment: 1 $ 405.00

Couple Rate full payment: 1 $ 540.00

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

Check the box *
Should be Empty: