Minister Information Form

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DATE

NAME(Required)

Title First Middle Last Suffix

HOME ADDRESS(Required)

Street Address Mailing Address (if different from above) City State ZIP Code

PREFERRED EMAIL(Required)

SECONDARY EMAIL

MOBILE PHONE(Required)

DATE OF BIRTH

SPOUSE NAME

First Middle Last

Spouse Email

Spouse Date of Birth

NAME OF EMERGENCY CONTACT (1)(Required)

First Last

Emercency Contact Email

Emergency Contact Phone

Relationship to you

NAME OF EMERGENCY CONTACT (2)

First Last

Emercency Contact Email

Emergency Contact Phone

Relationship to you

CHILDREN: (add additional lines with + button)

Their Date of Birth:

EDUCATION: Please list seminary(s), Degree awarded, Year

i.e. UDTS, MDiv, 2010

EDUCATION: Please list other institutions, Degree awarded

i.e. University of Illinois, B.A. Political Science

Other Continuing Education

ORDINATION: Church & Location

Ordination Date

Ordination Denomination (if not PCUSA)

Current or Past Presbytery / Synod / GA Involvement

How would you like to be involved in Blackhawk Presbytery?

CONTACT US

CALENDAR

MEMBER LOGIN

E-NEWS

FACEBOOK

DONATE

CONTACT US

CALENDAR

MEMBER LOGIN

DONATE

E-NEWS

FACEBOOK

Minister Information Form

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