New Member Credentials Payment Form

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 (prorated): $ 101.25

Couple Rate (prorated): $ 135.00

Newly Credentialed Form (One-time Payment)