Application

Application
Membership Level*

General Membership $50 (Valid for 12 Months)Clergy Membership $100 (Valid for 12 Months
Application Type*

MemberMinister in TrainingI am Called to be an Ordained MinisterI am an Ordained Minister
In what year were you Ordained?*
Which Body performed your Ordination?*
What Credential would you like us to use on your ID Card?*
Example: Ordained Minister
Your Name*

First NameLast Name
Your Mailing Address*

Street Address

Street Address Line 2

CityState

Zip Code
Email*
Phone Number*

Area CodePhone Number
Last 4 of Your Social Security Number*
Date of Birth*
Month Day Year
Gender*

MaleFemale
How did you hear about us?*
Should be Empty: