Join the team! (Basic Information about Careers and Training)

Ministerial Studies Enrollment Form

Association of Christian Chaplains

Member and Organization Application

If applicant is ordained or Licensed in another church, attach copy of ordination or license to the application with appropriate fee(s).

  ($12 Annual $5.95 S&H for Certificate of Membership)

Mail To: Association of Christian Chaplains

Our Daily Bread, Missions Organization

Box 1934

Redmond, OR 97756

Date_____________

1. Personal Information:

A. Name in Full Last_________________First_____________ MI ______

B. Social Security Number _______-_____-_________

C. U.S. Citizen Yes ___ No ___ Country of Citizenship if no________

D. Mailing Address _______________________________________

City__________________ State __________ 

Zip _________-________

E. Phone: Home _________________ 

Work ________________ (Optional)

F. Birth date ______________ 

Birth Place ______________________

G. Male___ Female ____ 

In case of Emergency _________________

H. Email Address ______________________________

2. Christian Life

A. Briefly on a separate piece of paper, write your testimony.

B. Present Church Membership or affiliation,

Name of Church or Membership ___________________________

Pastors Name ______________________

Address_______________________________________________

 

3. Education:

Grade School _____________________________________________

High School _____________________________________________

Bible School _____________________________________________

College ______________________________________________

5. References:

1) Name _______________________________________

Address, City, State, Zip ___________________________________

2) Name _______________________________________

Address, City, State, Zip ___________________________________

3) Name _______________________________________

Address, City, State, Zip ___________________________________

Pastor _________________________________________

Address, City, State, Zip ___________________________________

6. Church Affiliation:

                    Name of church, organization, or charter organization you work for:

                    __________________________________________________

                    Address of church or organization:

                    __________________________________________________

                    E-Mail Address _____________________________________

                    Phone (        ) __________-____________________

Certification: I the undersigned have read and agreed to your Articles of Faith

Signature ________________________________________

Date ______________________