Membership Record - National Black Fellowship Of The Assemblies Of God

First Name *

Last Name *

Email Address *

Street Address *

Apartment, suite, etc

City *

State/Province *

ZIP / Postal Code

Mobile Phone *

Birthday *

Race

Marital StatusMarriedSingle

Spouse's Name

Present Ministry

If Sr Pastor, Church Name

If Staff, Church Name

Location & Address

GPH Account #0 / 6

District *

Region *

Do you hold credentials? *

If so, choose one

Member of what section?

Does your spouse hold credentials? *

If so, choose one

Member of what section?

EmailPhone

I acknowledge