MCHCA Signup 2

Church Name
Jurisdictional Region

Church Mailing Address:
Street
City
State
Zip
Country

Church Physical Address:
Street
City
State
Zip
Country
Phone #
Fax #
Does your church have a website?
Church Web Address:
If not applicable, would you like assistance in designing a presence?
Church Logo
If not applicable, would you like assistance in designing a logo?
Church Anniversary Date

Alternate Church Contact (Personnel other than Pastor/Spouse)
Name
Email
Phone #

Pastor's Name
Phone #
Primary Email Address
Secondary Email Address
Home Address
City
State
Zip
Mailing Address
City
State
Zip
Pastor's Birthday
Pastor's Anniversary Date
Number of Years Pastoring
Pastor's Adjutant Name
Title
Email Address
Phone #

Spouse's Name
Spouse's Email Address
Home Address
City
State
Zip
Spouse's Mailing Address
City
State
Zip
Spouse's Contact Number
Children (Name/Gender - Specify if under 25)
Spouse's Birthday
Spouse's Adjutant Name
Title
Email Address
Phone #

Please identify a primary point of contact for the applicable Auxiliary/Ministries within your Assembly: Administration; Education/Training (Sunday School-Bible Study); Evangelism; Finance; Foreign Affairs; Marketing; Men’s Ministry; Nurses; Protocol -Adjutant Core; Security; Technology; Transportation; Ushers; Women’s Ministry; Worship & Arts–Music; Youth & Young Adult

Auxiliary/Ministry
Name
Title
Phone #
Email (Primary)
Auxiliary/Ministry
Name
Title
Phone #
Email (Primary)
Auxiliary/Ministry
Name
Title
Phone #
Email (Primary)
Auxiliary/Ministry
Name
Title
Phone #
Email (Primary)
Auxiliary/Ministry
Name
Title
Phone #
Email (Primary)
Auxiliary/Ministry
Name
Title
Phone #
Email (Primary)
Auxiliary/Ministry
Name
Title
Phone #
Email (Primary)
Auxiliary/Ministry
Name
Title
Phone #
Email (Primary)
Auxiliary/Ministry
Name
Title
Phone #
Email (Primary)
Auxiliary/Ministry
Name
Title
Phone #
Email (Primary)
Auxiliary/Ministry
Name
Title
Phone #
Email (Primary)
Auxiliary/Ministry
Name
Title
Phone #
Email (Primary)
Auxiliary/Ministry
Name
Title
Phone #
Email (Primary)
Auxiliary/Ministry
Name
Title
Phone #
Email (Primary)
Auxiliary/Ministry
Name
Title
Phone #
Email (Primary)
Auxiliary/Ministry
Name
Title
Phone #
Email (Primary)
Auxiliary/Ministry
Name
Title
Phone #
Email (Primary)