Church/Organization Membership Form

Church/Organization Name _______________________________________

Address ________________________________

City ___________________________________

State ______ Zip ____________

Phone (____) _____________   Fax (____) _____________

E-mail ___________________________________

Pastor/President’s Name ________________________________________

Please identify additional contact persons for unit emphases:

Women in Missions

Name _______________________________________

Address _____________________________________

City ___________________________________

State ______ Zip ____________

Phone (____) _____________   Fax (____) _____________

E-mail ___________________________________
 

Men in Missions

Name _______________________________________

Address _____________________________________

City ___________________________________

State ______ Zip ____________

Phone (____) _____________   Fax (____) _____________

E-mail ___________________________________

Youth in Missions

Name _______________________________________

Address _____________________________________

City ___________________________________

State ______ Zip ____________

Phone (____) _____________   Fax (____) _____________

E-mail ___________________________________

HIV/AIDS

Name _______________________________________

Address _____________________________________

City ___________________________________

State ______ Zip ____________

Phone (____) _____________   Fax (____) _____________

E-mail ___________________________________

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