Name *

First Name

Last Name

Address *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Phone *

(###)

###

####

Date of Birth *

MM

DD

YYYY

Marital Status *

Single

Married

Divorced

Divorced & Remarried

Widower/Widow

Are you ordained?

Yes

No

May we contact this minister? *

Yes

No

High School Diploma

Yes

No

GED

Yes

No

College Degree

Yes

No

Type of Degree

Certificate

Associate

Bachelors

Masters

Doctorate

Doctrinal Affirmation *

Please check each statement

I believe in God who alone is omniscient, omnipresent and omnipotent.

I believe the Bible is the infallible word of God, inspired by God and written by Holy Men as they were moved by the Holy Ghost.

I believe that God has revealed himself to man as the father in creation, the son in redemption and the Holy Spirit in inspiration and guidance. I John 5:7, John 1:14

I believe in the oneness of God and Christ Jesus and that there is none other name under heaven given among me whereby we must be saved. John 1:1-14, Acts 4:12

I believe that God's perfect plan of salvation includes repentance, water baptism by immersion in the name of Jesus and the infilling of the Holy Spirit. John 3:5-8, Acts 2:38, Acts 2:4

I believe that the baptism of the Holy Ghost will empower us for service unto the Lord "and he that speaketh in an unknown tongue edifieth himself by speaking unto God". I Cor. 14 1-4

I believe in the gift of tongues as recorded in I Cor. 12:1-11

I believe in the pre-tribulation rapture of the church.

I believe the apostles of Jesus Christ projected the true message of salvation.

I believe that the wages of sin is death; but the gift of God is eternal life through Jesus Christ our Lord. Romans 6:23

What is your principle calling? *

Apostle

Teacher

Evangelist

Minister

Missionary

Pastor

Prophet

Not sure

Other

Do you need training? *

Yes

No