Date:

Church Name:     

Church Address:

                       

 

Church Mailing Address

(If Different):

                         

 

Church Phone:    

Church Email(s):    

Alternate EMail:   

 

Regular Worship Schedule:

                      

 

                       

Bible Translation

Used in Worship:

 

Please list 4 or 5 lay persons or couples in your church:

                      

 

 

Name:     

Address:

               

EMail:       

Phone:     

Cell Phone:

 

Family Info:

  Wife:     

  Children's names/ages/school grade:

              

  

 

 

Comments:

              

Press to send to the Associational Coordinator: