Church Mailing Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Phone

(###)

###

####

FAX

(###)

###

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Church Start Date

MM

DD

YYYY

Name *

First Name

Last Name

Present Facility Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Name of Pastor

First Name

Last Name

Pastor's Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Pastor's Phone/ Cell

(###)

###

####

Date Ordained / Licensed

MM

DD

YYYY

Highest Level of Education

GED/ High School Diploma

Undergraduate College Degree

Master's Degree

Doctorate

Spouse Name

First Name

Last Name