Name *

First Name

Last Name

Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Phone (Mobile)

(###)

###

####

Birthdate

MM

DD

YYYY

Spouse Name

First Name

Last Name

Type of Church Government

Which type of Church Government do you ascribe to? (Put an X in the appropriate circle(s)) Below are the three types of church governments. To which do you ascribe?

Congregational (Single Pastor)

Plurality of Leaders

Combination of both