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Spouse's Name:	First (Optional)
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Spouse's Email:	(Optional) (Please only provide if different from husband's)
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Birthday(s):	Your Birthday      MM Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec DD 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 YEAR 2003 2002 2001 2000 1999 1998 1997 1996 1995 1994 1993 1992 1991 1990 1989 1988 1987 1986 1985 1984 1983 1982 1981 1980 1979 1978 1977 1976 1975 1974 1973 1972 1971 1970 1969 1968 1967 1966 1965 1964 1963 1962 1961 1960 1959 1958 1957 1956 1955 1954 1953 1952 1951 1950 1949 1948 1947 1946 1945 1944 1943 1942 1941 1940 1939 1938 1937 1936 1935 1934 1933 1932 1931 1930 1929 1928 1927 1926 1925 1924 1923 1922 1921 1920 1919 1918 1917 1916 1915 1914 1913 1912 1911 1910 1909 1908 1907 1906 1905 1904 1903 1902 1901 1900 1899 1898 1897 1896 1895 1894 1893 (Optional) Spouse's Birthday MM Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec DD 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 YEAR 2003 2002 2001 2000 1999 1998 1997 1996 1995 1994 1993 1992 1991 1990 1989 1988 1987 1986 1985 1984 1983 1982 1981 1980 1979 1978 1977 1976 1975 1974 1973 1972 1971 1970 1969 1968 1967 1966 1965 1964 1963 1962 1961 1960 1959 1958 1957 1956 1955 1954 1953 1952 1951 1950 1949 1948 1947 1946 1945 1944 1943 1942 1941 1940 1939 1938 1937 1936 1935 1934 1933 1932 1931 1930 1929 1928 1927 1926 1925 1924 1923 1922 1921 1920 1919 1918 1917 1916 1915 1914 1913 1912 1911 1910 1909 1908 1907 1906 1905 1904 1903 1902 1901 1900 1899 1898 1897 1896 1895 1894 1893 (Optional) Only if you don't mind it being listed on our Birthday / Anniversary Page
Date Married:	MM Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec DD 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 YEAR 2003 2002 2001 2000 1999 1998 1997 1996 1995 1994 1993 1992 1991 1990 1989 1988 1987 1986 1985 1984 1983 1982 1981 1980 1979 1978 1977 1976 1975 1974 1973 1972 1971 1970 1969 1968 1967 1966 1965 1964 1963 1962 1961 1960 1959 1958 1957 1956 1955 1954 1953 1952 1951 1950 1949 1948 1947 1946 1945 1944 1943 1942 1941 1940 1939 1938 1937 1936 1935 1934 1933 1932 1931 1930 1929 1928 1927 1926 1925 1924 1923 1922 1921 1920 1919 1918 1917 1916 1915 1914 1913 1912 1911 1910 1909 1908 1907 1906 1905 1904 1903 1902 1901 1900 1899 1898 1897 1896 1895 1894 1893 (Optional) Only if you don't mind it being listed on our Birthday / Anniversary Page
Date Baptized:	MM Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec DD 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 YEAR 2003 2002 2001 2000 1999 1998 1997 1996 1995 1994 1993 1992 1991 1990 1989 1988 1987 1986 1985 1984 1983 1982 1981 1980 1979 1978 1977 1976 1975 1974 1973 1972 1971 1970 1969 1968 1967 1966 1965 1964 1963 1962 1961 1960 1959 1958 1957 1956 1955 1954 1953 1952 1951 1950 1949 1948 1947 1946 1945 1944 1943 1942 1941 1940 1939 1938 1937 1936 1935 1934 1933 1932 1931 1930 1929 1928 1927 1926 1925 1924 1923 1922 1921 1920 1919 1918 1917 1916 1915 1914 1913 1912 1911 1910 1909 1908 1907 1906 1905 1904 1903 1902 1901 1900 1899 1898 1897 1896 1895 1894 1893  (Optional)
Baptized By:	(Optional)
Date Baptized:	MM Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec DD 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 YEAR 2003 2002 2001 2000 1999 1998 1997 1996 1995 1994 1993 1992 1991 1990 1989 1988 1987 1986 1985 1984 1983 1982 1981 1980 1979 1978 1977 1976 1975 1974 1973 1972 1971 1970 1969 1968 1967 1966 1965 1964 1963 1962 1961 1960 1959 1958 1957 1956 1955 1954 1953 1952 1951 1950 1949 1948 1947 1946 1945 1944 1943 1942 1941 1940 1939 1938 1937 1936 1935 1934 1933 1932 1931 1930 1929 1928 1927 1926 1925 1924 1923 1922 1921 1920 1919 1918 1917 1916 1915 1914 1913 1912 1911 1910 1909 1908 1907 1906 1905 1904 1903 1902 1901 1900 1899 1898 1897 1896 1895 1894 1893    Spouse's (Optional)
Baptized By:	Spouse's (Optional)

Home Address:
Address (cont.)
City
State/Province	Select One OT - OTHER COUNTRIES (not in the U.S.) AK - ALASKA AL - ALABAMA AR - ARKANSAS AZ - ARIZONA CA - CALIFORNIA CO - COLORADO CT - CONNECTICUT DC - DISTRICT OF COLUMBIA DE - DELAWARE FL - FLORIDA GA - GEORGIA GU - GUAM HI - HAWAII IA - IOWA ID - IDAHO IL - ILLINOIS IN - INDIANA KS - KANSAS KY - KENTUCKY LA - LOUISIANA MA - MASSACHUSETTS MD - MARYLAND ME - MAINE MI - MICHIGAN MN - MINNESOTA MO - MISSOURI MS - MISSISSIPPI MT - MONTANA NC - NORTH CAROLINA ND - NORTH DAKOTA NE - NEBRASKA NH - NEW HAMPSHIRE NJ - NEW JERSEY NM - NEW MEXICO NV - NEVADA NY - NEW YORK OH - OHIO OK - OKLAHOMA OR - OREGON PA - PENNSYLVANIA PR - PUERTO RICO RI - RHODE SC - SOUTH CAROLINA SD - SOUTH DAKOTA TN - TENNESSEE TX - TEXAS UT - UTAH VA - VIRGINIA VI - VIRGIN ISLANDS VT - VERMONT WA - WASHINGTON WI - WISCONSIN WV - WEST VIRGINA WY - WYOMING
Zip/Postal Code
Country	USA Albania Algeria American Samoa Andorra Angola Anguilla Antarctica Antigua And Barbuda Argentina Armenia Aruba Australia Austria Azerbaijan Bahamas Bahrain Bangladesh Barbados Belarus Belgium Belize Benin Bermuda Bhutan Bolivia Bosnia and Herzegowina Botswana Bouvet Island Brazil British Indian Ocean Territory Brunei Darussalam Bulgaria Burkina Faso Burma Burundi Cambodia Cameroon Canada Cape Verde Cayman Islands Central African Republic Chad Chile China Christmas Island Cocos (Keeling) Islands Colombia Comoros Congo Congo, the Democratic Republic of the Cook Islands Costa Rica Cote d'Ivoire Croatia Cyprus Czech Republic Denmark Djibouti Dominica Dominican Republic East Timor Ecuador Egypt El Salvador England Equatorial Guinea Eritrea Espana Estonia Ethiopia Falkland Islands Faroe Islands Fiji Finland France French Guiana French Polynesia French Southern Territories Gabon Gambia Georgia Germany Ghana Gibraltar Great Britain Greece Greenland Grenada Guadeloupe Guam Guatemala Guinea Guinea-Bissau Guyana Haiti Heard and Mc Donald Islands Honduras Hong Kong Hungary Iceland India Indonesia Ireland Israel Italy Jamaica Japan Jordan Kazakhstan Kenya Kiribati Korea, Republic of Korea (South) Kuwait Kyrgyzstan Lao People's Democratic Republic Latvia Lebanon Lesotho Liberia Liechtenstein Lithuania Luxembourg Macau Macedonia Madagascar Malawi Malaysia Maldives Mali Malta Marshall Islands Martinique Mauritania Mauritius Mayotte Mexico Micronesia, Federated States of Moldova, Republic of Monaco Mongolia Montserrat Morocco Mozambique Myanmar Namibia Nauru Nepal Netherlands Netherlands Antilles New Caledonia New Zealand Nicaragua Niger Nigeria Niue Norfolk Island Northern Ireland Northern Mariana Islands Norway Oman Pakistan Palau Panama Papua New Guinea Paraguay Peru Philippines Pitcairn Poland Portugal Puerto Rico Qatar Reunion Romania Russia Russian Federation Rwanda Saint Kitts and Nevis Saint Lucia Saint Vincent and the Grenadines Samoa (Independent) San Marino Sao Tome and Principe Saudi Arabia Scotland Senegal Seychelles Sierra Leone Singapore Slovakia Slovenia Solomon Islands Somalia South Africa South Georgia and the South Sandwich Islands South Korea Spain Sri Lanka St. Helena St. Pierre and Miquelon Suriname Svalbard and Jan Mayen Islands Swaziland Sweden Switzerland Taiwan Tajikistan Tanzania Thailand Togo Tokelau Tonga Trinidad Trinidad and Tobago Tunisia Turkey Turkmenistan Turks and Caicos Islands Tuvalu Uganda Ukraine United Arab Emirates United Kingdom United States United States Minor Outlying Islands Uruguay Uzbekistan Vanuatu Venezuela Viet Nam Virgin Islands (British) Virgin Islands (U.S.) Wales Wallis and Futuna Islands Western Sahara Yemen Zambia Zimbabwe
Congregational Information Where You Attend
Congregation	Select One Not Listed AK - Kenai - Linwood Lane Church of Christ AL - Athens - Evans Road Church of Christ AL - Athens - Sandefer Road Church of Christ AL - Birmingham - Crescent Ridge Church of Christ AL - Cullman - Bethel Church of Christ AL - Dothan - Hartford Highway Church of Christ AL - Florala - State Line Church of Christ AL - Gadsden - Gadsden Church of Christ AL - Kinston - Earlytown Church of Christ AL - Lowery - Lowery Church of Christ AL - Montgomery - Vonora Avenue Church of Christ AL - Napoleon - Napoleon Church of Christ AL - Opp - Highway 84 East Church of Christ AL - Pansey - Pansey Church of Christ AL - Piedmont - Highway 278 Church of Christ AL - Robertsdale - Hillcrest Church of Christ AL - Slocomb - Esto Highway Church of Christ AR - Cedar Creek - Cedar Creek Church of Christ AR - Clinton - Scotland Church of Christ AR - Dardanelle - Dardanelle Church of Christ AR - Floral - Jamestown Mountain Church of Christ AR - Foreman - Oak Grove Church of Christ AR - Ft. Smith - Texas Road Church of Christ AR - Harrison - Highway Church of Christ AR - Hartwell - Hartwell Church of Christ AR - Iuka - Iuka Church of Christ AR - Junction City - Junction City Church of Christ AR - Lamar - Highway 64 Church of Christ AR - Lead Hill - Locust Church of Christ AR - Little Rock - Little Rock Church of Christ AR - Mcrae - Mcrae Church of Christ AR - Mena - Mena Church of Christ AR - Mountain Home - Cross & Wade Church of Christ AR - Norfork - Lone Rock Church of Christ AR - Pocahontas - Hillside Church of Christ AR - Pottsville - Pottsville Church of Christ AR - Rogers - South 13th Street Church of Christ AR - Russellville - Russellville Church of Christ AR - Strong - Strong Church of Christ AR - Witt Springs - Witt Springs Church of Christ AZ - Glendale - Glendale Church of Christ AZ - Tucson - Los Altos Ave Church of Christ AZ - Tucson - Country Club Drive Church of Christ CA - Atwater - Atwater Church of Christ CA - Auburn - Auburn Church of Christ CA - Bakersfield - Brundage Lane Church of Christ CA - Bakersfield - Planz Road Church of Christ CA - Benicia - NorthBay Church of Christ CA - Ceres - Ceres Church of Christ CA - Clovis - Clovis Church of Christ CA - Covina - Covina Church of Christ CA - El Cajon - El Cajon Church of Christ CA - El Centro - El Centro Church of Christ CA - Escalon - Escalon Church of Christ CA - Fair Oaks - Fair Oaks Church of Christ CA - Fortuna/Rio Dell - Monument Road Church of Christ CA - Fremont - Fremont Church of Christ CA - Grass Valley - Grass Valley Church of Christ CA - Hawthorne - Hawthorne Church of Christ CA - Huntington Park - Huntington Park Church of Christ CA - Huntington Park - Huntington Park Church of Christ (Spanish Services) CA - Ione - North Villiage Church of Christ CA - Lodi - Garfield Street Church of Christ CA - Manteca - Manteca Church of Christ CA - Modesto - Modesto Church of Christ CA - Norco - Norco Church of Christ CA - Oakdale - Oakdale Church of Christ CA - Ojai - Ojai Church of Christ CA - Olivehurst - Olivehurst Church of Christ CA - Orange - Orange Church of Christ CA - Placerville - Placerville Church of Christ CA - Porterville - Porterville Church of Christ CA - Porterville - Porterville Church of Christ (Spanish Services) CA - Redding - Redding Church of Christ CA - Sacramento - 64th Street Church of Christ CA - Sacramento - North Area Church of Christ CA - Salinas - Salinas Church of Christ (Spanish - English Bilengual) CA - San Diego - San Diego Church of Christ CA - San Marcos - San Marcos Church of Christ CA - Sanger - Sanger Church of Christ CA - Santa Rosa - Santa Rosa Church of Christ CA - Stockton - Stockton Church of Christ CA - Tehachapi - Tehachapi Church of Christ CA - Temecula - Temecula Church of Christ CA - Turlock - Turlock Church of Christ CA - Ventura - Ventura Church of Christ CA - Woodlake - Woodlake Church of Christ CA - Yuba City - Yuba City Church of Christ CO - Canon City - Canon City Church of Christ CO - Denver - Berthoud Church of Christ CO - Denver - Broomfield Church of Christ CO - Holyoke - Emerson Street Church of Christ CO - Otis - Otis Church of Christ FL - Crestview - Crestview Church of Christ FL - Hernando - Hernando Church of Christ FL - Hudson - Hudson Church of Christ FL - Jacksonville - Cedarhurst Church of Christ FL - Jay - West Side Church of Christ FL - Longwood - Longwood Church of Christ FL - North Ft. Myers - Slator Road Church of Christ FL - Orlando - Orlo Vista Church of Christ FL - Panama City - Michigan Avenue Church of Christ FL - Sorrento - Sorrento Church of Christ FL - Tallahassee - Oyster Bay Church of Christ FL - Tampa - Nebraska Heights Church of Christ GA - Atlanta - Austell Road Church of Christ - Marietta GA - Atlanta - Jonesboro Church of Christ GA - Atlanta - Henry County Church of Christ GA - Columbus - Thirty-first Street Church of Christ GA - La Grange - Murphy Ave. Church of Christ GA - Macon - Knoxville Church of Christ GA - Temple - Temple Church of Christ GA - West Point - Roper Heights Church of Christ HI - Oahu - Waipahu Church of Christ IA - Bloomfield - Bloomfield Church of Christ IA - Cedar Rapids - Southeast Church of Christ IA - Cedar Rapids - Marion Church of Christ IA - Des Moines - Mc Kinley Avenue Church of Christ IA - Grinnell - Grinnell Church of Christ IA - Ottumwa - Ottumwa Church of Christ IA - Waterloo - Waterloo Church of Christ ID - Caldwell, Nampa & Melba - Canyon County Church of Christ ID - Northwest - Helmer Church of Christ IL - Chicago - Lowe Church of Christ IL - Cowden - Cowden Church of Christ IL - Glen Ellyn - Dupage Church of Christ IL - Mozier - Mozier Church of Christ IL - Peoria - Church of Christ IN - Bedford - North Bedford Church of Christ IN - Bloomington - Bloomington Church of Christ IN - Bloomington - Hillside Church of Christ IN - Bloomington - South Washington Street Church of Christ IN - Brazil - Brazil Church of Christ IN - Brazil - Church of Christ on Franklin Street IN - Depaw - Depaw Church of Christ IN - Harrodsburg - Harrodsburg Church of Christ IN - Harrodsburg - Lake Monroe Church of Christ IN - Indianapolis - Avon Church of Christ IN - Mitchell - Pleasant View Church of Christ IN - Pleasant Grove - Pleasant Grove Church of Christ IN - Richmond - Richmond Church of Christ IN - Spencer - North Washington Street Church of Christ KS - Kansas City - North 36th Street Church of Christ KS - Kansas City - Stony Point Church of Christ KS - Lawrence - East Lawrence Church of Christ KS - Linwood - Linwood Church of Christ KS - Wichita - Heartland Church of Christ KY - Bandy - Bandy Church of Christ KY - Beattyville - Bear Track Church of Christ KY - Beech Fork - Beech Fork Church of Christ KY - Bowling Green - Rockfield Church of Christ KY - Chestnut Ridge - Chestnut Ridge Church of Christ KY - Davella - Davella Church of Christ KY - Inez - Rock Castle Church of Christ KY - Labascus - Labascus Church of Christ KY - Lexington - Lexington Church of Christ KY - Liberty - Hill Top Church of Christ KY - London - South Side Church of Christ KY - Mt. Vernon - Mt. Vernon Church of Christ KY - Mt. Vernon - Brodhead Church of Christ KY - Mt. Vernon - Blue Springs Church of Christ KY - Paducah - Paducah Church of Christ KY - Somerset - Walnut Grove Church of Christ LA - Baton Rouge - Foster Road Church of Christ LA - Fairview - Fairview Church of Christ LA - Farmerville - Betty St. Church of Christ LA - Farmerville - Farmerville Church of Christ LA - Farmerville - D'Arbonne Church of Christ LA - Farmerville - Conway Church of Christ LA - Hammond - Pineview Church of Christ LA - Jerusalem - Jerusalem Church of Christ LA - Monroe - Garrett Road Church of Christ LA - Shreveport - Buncomb Road Chruch of Christ LA - Shreveport - Queensborough Church of Christ LA - Shreveport - Midway Church of Christ LA - Shreveport - South Shreveport Church of Christ LA - West Lake - West Lake Church of Christ LA - West Monroe - Claiborne Church of Christ MI - Detroit - Detroit Church of Christ MI - Grand Rapids - Wyoming Church of Christ MI - Pontiac - Waterford Church of Christ MI - Prescott - Prescott Church of Christ MN - Minneapolis/st. Paul - Lakeland Church of Christ MO - Alton - Oak Forest Church of Christ MO - Anderson - Anderson Church of Christ MO - Aurora - Southern Hills Church of Christ MO - Ava - Northwest Twelfth Street Church of Christ MO - Bendavis - Bendavis Church of Christ MO - Branson/springfield - Church of Christ in Ozark MO - Brumley - Brumley Church of Christ MO - Buffalo - Buffalo Church of Christ MO - Cassville - Cassville Church of Christ MO - Columbia - Rice Road Church of Christ MO - Doniphan - Town and Country Church of Christ MO - Edwards - Cable Ridge Church of Christ MO - Eldon - Eldon Church of Christ MO - Galena - Mountain Home Church of Christ MO - Grandview - Grandview Church of Christ MO - Greenfield - Greenfield Church of Christ MO - Grovespring - Claxton Church of Christ MO - Harrisonville - Harrisonville Church of Christ MO - Houston - Houston Church of Christ MO - Jamesville - Jamesville Church of Christ MO - Joplin - Leawood Village Church of Christ MO - Joplin - Burkhart Church of Christ MO - Joplin - Stapleton Church of Christ MO - Joplin - Beef Branch Church of Christ MO - Kansas City - Church of Christ on Agnes Street MO - Kansas City - Church of Christ on 85th & Euclid MO - Kansas City - North Brighton Street Church of Christ MO - Kansas City - Church of Christ on Prospect Avenue MO - Lebanon - Lebanon Church of Christ MO - Lees Summit - Lees Summit Church of Christ MO - Marshfield - Wildwood Church of Christ MO - Monett - Monett Church of Christ MO - Montreal - Montreal Church of Christ MO - Mountain Grove - Fieldstone Church of Christ MO - Mtn. Grove - Southside Church of Christ MO - Neosho - West Highway 60 Church of Christ MO - Niangua - Church of Christ in Niangua MO - Odom - Odom Church of Christ MO - Ozark - Ozark Church of Christ MO - Pleasant Hill - Pleasant Hill Church of Christ MO - Powe - Powe Church of Christ MO - Rolla - Rolla Church of Christ MO - Seneca - Stateline Church of Christ MO - Seneca - Swars Prairie Church of Christ MO - Seymour - Seymour Church of Christ MO - Springfield - Mission Hills Church of Christ MO - Springfield - Northside Church of Christ MO - Springfield - Springfield Church of Christ on Hwy 160 MO - St. Louis - Chain of Rocks Church of Christ MO - St. Louis - St. Louis Church of Christ MO - Warsaw - Warsaw Church of Christ MO - West Plains - Missouri Avenue Church of Christ MO - West Plains - Ab Highway Church of Christ MS - Brookhaven - Jericho Church of Christ MS - Brookhaven - New Hope Church of Christ MS - Brookhaven - New Salem Church of Chris| MS - Brookhaven - The Church of Chirst at 84 W formerly Pearlhaven Church of Christ MS - Brookhaven - Hillcrest Church of Christ MS - Collins - Covington County Church of Christ MS - Hazelhurst - Jerusalem Church of Christ MS - Jackson - Mc Cluer Road Church of Christ NC - Burlington - Park Avenue Church of Christ NC - Raleigh - Falls of Neuse Road Church of Christ NC - Winston/salem - Lexington Church of Christ NE - Imperial - Imperial Church of Christ NJ - Clayton - Clayton Church of Christ on 7th Avenue NJ - Willingboro - Willingboro Church of Christ NM - Farmington - Farmington Church of Christ NM - Portales - North Side Church of Christ NY - Kingston - Ulster County Church of Christ OH - Akron - Brimfield Church of Christ OH - Chesapeake - Chesapeake Church of Christ OH - Chesapeake - Linnville Church of Christ OH - Cincinnati - Dallasburg (Goshen) Church of Christ OH - Cincinnati - Hamilton Church of Christ OH - Cincinnati - Sharonville Church of Christ OH - Cincinnati - West Chester Church of Christ OH - Columbus - Parsons Avenue Church of Christ OH - Columbus - Lockborne Road Church of Christ OH - Danville - Danville Church of Christ OH - Dayton - Family Church of Christ OH - Fayetteville - Fayetteville Church of Christ OH - Killbuck - Locust Grove Church of Christ OH - Long Bottom - Red Brush Church of Christ OH - Proctorville - Proctorville Church of Christ OK - Ada - Ada Church of Christ OK - Alderson - Alderson Church of Christ OK - Ardmore - Ardmore Church of Christ OK - Broken Bow - Golden Church of Christ OK - Broken Bow - Sweet Home Church of Christ OK - Chouteau - Chouteau Church of Christ OK - Coalgate - Legal Church of Christ OK - Council Hill - Council Hill Church of Christ OK - Crescent - Crescent Church of Christ OK - Davis - Davis Church of Christ OK - Duncan - Duncan Church of Christ OK - Edmond - Oakwood Church of Christ OK - El Reno - Parkview Church of Christ OK - Frederick - Frederick Church of Christ OK - Galey - Galey Church of Christ OK - Healdton - Healdton Church of Christ OK - Henryetta - Gentry Street Church of Christ OK - Holdenville - Holdenville Church of Christ OK - Jennings - Jennings Church of Christ OK - Lexington - Lexington Church of Christ OK - McAlester - C. & Tyler Church of Christ OK - Miami - Whispering Hills Church of Christ OK - Moore - Moore Church of Christ OK - Muskogee - Southwest Church of Christ OK - Newcastle - Whispering Pines Church of Christ OK - Okemah - Okemah Church of Christ OK - Oklahoma City - Capitol Hill Church of Christ OK - Oklahoma City - Northwest Twenty-first Street Church of Christ OK - Oklahoma City - Southwest 50th Street Church of Christ OK - Oklahoma City - Village Church of Christ OK - Oklahoma City - Norman Church of Christ OK - Oklahoma City - Capitol Hill Church of Christ (Spanish Speaking) OK - Ratliff City - Ratliff City Church of Christ OK - Seminole - Good Hope Church of Christ OK - Sentinel - Church of Christ on South 11th Street OK - Stilwell - Noel Chapel Church of Christ OK - Sulphur - Sulphur Church of Christ OK - Tahlequah - Qualls Road Church of Christ OK - Tucker - Tucker Church of Christ OK - Tulsa - Tulsa Church of Christ OK - Tulsa - Eleventh Street Acres Congregation OK - Tulsa - Broken Arrow Church of Christ OK - Valliant - Eastside Church of Christ OK - Washington - Washington Church of Christ OK - Wynnewood - Wynnewood Church of Christ OR - Albany - Albany Church of Christ OR - Cottage Grove - Cottage Grove Church of Christ OR - Forest Grove - Forest Grove Church of Christ OR - Grants Pass - Grants Pass Church of Christ OR - Lagrande - Lagrande Church of Christ OR - Odell - Odell Church of Christ OR - Salem - Dover Avenue Church of Christ OR - Wilsonville/Portland - Wilsonville Church of Christ OT - Ambato - Iglesia de Cristo OT - Australia - Armadale Church of Christ OT - Ciudad Victoria - Iglesia de Cristo in Ciudad Victoria OT - Dipolog City - Dipolog Church of Christ OT - Far East - Baguuio OT - General Santos City - Church of Christ Gensan OT - Ghana - Ghana Churches of Christ OT - Kuala Lumpur - Kuala Lumpur Church of Christ OT - Malawi - Malawi Churches of Christ OT - Mozambique - Mozambique Churches of Christ OT - New Brunswick - Moncton Church of Christ OT - Nigeria - Nigeria Churches of Christ OT - Nuevo Leon - Iglesia de Cristo in Nuevo Leon OT - Republic of South Africa - Republic of South Africa Churches of Christ OT - South America - La Iglesia de Cristo OT - Toronto - Toronto Church of Christ OT - Zambia - Zambia Churches of Christ OT - Zimbabwe - Zimbabwe Churches of Christ PA - Clearfield - Clearfield Church of Christ PA - Commodore - Lovejoy Church of Christ PA - Flemington - Flemington Church of Christ PA - Greenville - Shenango Church of Christ PA - Indiana - Pleasant Valley Church of Christ PA - Lecontes Mills - Lecontes Mills Church of Christ PA - Philadelphia - Philadelphia Church of Christ PA - Philadelphia - Church of Christ at Oxford Street PA - Rote - Rote Church of Christ SC - Florence - Paul Jones Road Church of Christ SC - Greenville - Berea Church of Christ SC - Walterboro - Live Oak Street Church of Christ TN - - Dover Church of Christ TN - Burns - Church of Christ at Burns TN - Chattanooga - State Line Church of Christ in Jasper TN - Crossville - Crossville Church of Christ TN - Flintville - Flintville Church of Christ TN - Hartford - Grassy Fork Church of Christ TN - Lawrenceburg - Springer Road Church of Christ TN - Lawrenceburg - Union Hill Church of Christ TN - Lawrenceburg - Chapel Grove Church of Christ TN - Memphis - Memphis Church of Christ TN - Memphis - Hollywood Street Church of Christ TN - Murfreesboro - Hillview Church of Christ TN - Nashville - Brookside Church of Christ TN - White Bluff - Hickorywood Church of Christ TX - Abilene - South Park Church of Christ TX - Abilene - Northside Church of Christ in Clyde TX - Amarillo - Grand Street Church of Christ TX - Andrews - South Side Church of Christ TX - Athens - Athens Church of Christ TX - Austin - Church of Christ on 43rd Street TX - Austin - North Loop Church of Christ TX - Austin - Fifty Second & Avenue F. Church of Christ TX - Austin - Church of Christ on Bluebonnet St. TX - Austin - Wells Branch Church of Christ TX - Austin - Deer Creek Church of Christ TX - Austin - Church of Christ on East Cesar Chavez TX - Azle - Tri-county Church of Christ TX - Beaumont - Beaumont Church of Christ TX - Belton - Sixth Street Church of Christ TX - Bridgeport - East Mound church of Christ TX - Brownwood - Avenue W Church of Christ TX - Cameron - Milan Plaza Church of Christ TX - Cameron - Hoyte Church of Christ TX - Cleburne - South Walnut Church of Christ TX - Corpus Christi - Bayview Church of Christ TX - Corsicana - W. 10th Ave Iglesia De Cristo TX - Corsicana - Corsicana Church of Christ TX - Dallas/Fort Worth - Dallas Church of Christ (Spanish Services) TX - Dallas/Fort Worth - Church of Christ on GreenOaks in Arlington TX - Dallas/Fort Worth - Duncanville Church of Christ TX - Dallas/Fort Worth - Davis Boulevard Church of Christ in Ft Worth TX - Dallas/Fort Worth - Fossil Creek Church of Christ in Ft Worth TX - Dallas/Fort Worth - North Beach Street, Ft Worth (Spanish Services) TX - Dallas/Fort Worth - Church of Christ in Frisco TX - Dallas/Fort Worth - Irving Church of Christ TX - Dallas/Fort Worth - Melissa Church of Christ TX - Dallas/Fort Worth - Church of Christ on Exchange Parkway in Allen TX - Dallas/Fort Worth - Northview Church of Christ (Rockwall) TX - Dallas/Fort Worth - Red Oak Church of Christ TX - Dallas/Forth Worth - Garland Iglesia de Cristo (Spanish Services) TX - De Leon - Southside Church of Christ TX - De Leon - Church of Christ at Rucker TX - Denison - South Crockett Street Church of Christ TX - El Paso - Church of Christ in El Paso TX - Galveston - La Marque Church of Christ TX - Graham - Second and Grove St. Church of Christ TX - Hamilton - Hamilton Church of Christ TX - Harlingen - Church of Christ in Harlingen TX - Houston - Fairbanks Church of Christ TX - Houston - Northeast Church of Christ TX - Houston - East Side Church of Christ in Deer Park TX - Jacksboro - North Side Church of Christ TX - Laredo - Laredo Church of Christ TX - Lubbock - 3rd & M Church of Christ in Levelland TX - Lubbock - Third Street Church of Christ TX - Lubbock - Spur Church of Christ TX - Marlin - Marlin Church of Christ TX - Marshall - Ash Springs Church of Christ TX - McGregor - Johnson Drive Church of Christ TX - Midland - Westway Church of Christ TX - Milano - Milano Church of Christ TX - Mineral Wells - Mineral Wells Church of Christ TX - Mullin - East Side Church of Christ TX - Odessa - University Boulevard Church of Christ TX - Olney - Olney Church of Christ TX - Paris - Paris Church of Christ TX - Port Arthur - Hazel Avenue Church of Christ TX - San Angelo - Eola Church of Christ TX - San Angelo - Nineteenth Street Church of Christ TX - San Antonio - Church of Christ on Glendora Ave. TX - San Antonio - Nacogdoches Road Church of Christ TX - San Antonio - Vance Jackson Road Church of Christ TX - San Antonio - Medina Church of Christ TX - San Antonio - Fairview Church of Christ TX - Sand Grove - Sand Grove Church of Christ TX - Seymour - Gilliland Church of Christ TX - Temple - White Hall Church of Christ TX - Texarkana - Eylau Church of Christ TX - Tyler - Tyler Church of Christ TX - Victoria - Victoria Church of Christ TX - Waco - Alta Vista Church of Christ TX - Waco - Monte Vista Church of Christ TX - Waco - Church of Christ on 23rd Street TX - Waco - Church of Christ on Circle Rd. (Spanish Services) TX - Weatherford - Bankhead Drive Church of Christ TX - Wichita Falls - Crestview Church of Christ TX - Wichita Falls - Gardens Edge Church of Christ TX - Woodson - East Side Church of Christ VA - Roanoke - East Gate Church of Christ VA - Woodlawn - Woodlawn Church of Christ WA - Kennewick - Kennewick Church of Christ WA - Portland - Vancouver Wa Church of Christ WA - Seattle - Pacific Church of Christ WA - Spokane - Medical Lake Church of Christ WA - Tonasket - Tonasket Church of Christ WA - Yakima - Yakima Church of Christ WI - Antigo - Antigo Church of Christ WV - Beatrice - Beatrice Church of Christ WV - Beckley - Piney View Church of Christ WV - Clintonville - Clintonville Church of Christ WV - Durbin - Durbin Church of Christ WV - Fairmont - Bunner Ridge Church of Christ WV - Foster - Foster Church of Christ WV - Huntington - Huntington Church of Christ WV - Huntington - Spring Valley Church of Christ WV - Jacksonburg - Ash Camp Church of Christ WV - Kirk - Dingess Church of Christ WV - Mount Liberty - Mount Liberty Church of Christ WV - Philippi - Philippi Church of Christ WV - Ranger - Laurel Hill Church of Christ WV - Shady Spring - Shady Spring Church of Christ WV - South Charleston - Mallory Chapel Church of Christ WV - South Charleston - Spring Hill Church of Christ WV - St. Albans - East End Church of Christ WV - Uneeda - Griffiths Branch Church of Christ WV - Wayne - Radnor Church of Christ WV - Wayne - Garretts Creek Church of Christ WV - Winifrede - Winifrede Church of Christ WY - Casper - Casper Church of Christ     Please supply your home congregation information below... Area: County: Optional Congregation Name: Congregation Address: Congregation City: State/Province: Select One OT - OTHER COUNTRY AK - ALASKA AL - ALABAMA AR - ARKANSAS AZ - ARIZONA CA - CALIFORNIA CO - COLORADO CT - CONNECTICUT DC - DISTRICT OF COLUMBIA DE - DELAWARE FL - FLORIDA GA - GEORGIA HI - HAWAII IA - IOWA ID - IDAHO IL - ILLINOIS IN - INDIANA KS - KANSAS KY - KENTUCKY LA - LOUISIANA MA - MASSACHUSETTS MD - MARYLAND ME - MAINE MI - MICHIGAN MN - MINNESOTA MO - MISSOURI MS - MISSISSIPPI MT - MONTANA NC - NORTH CAROLINA ND - NORTH DAKOTA NE - NEBRASKA NH - NEW HAMPSHIRE NJ - NEW JERSEY NM - NEW MEXICO NV - NEVADA NY - NEW YORK OH - OHIO OK - OKLAHOMA OR - OREGON PA - PENNSYLVANIA PR - PUERTO RICO RI - RHODE SC - SOUTH CAROLINA SD - SOUTH DAKOTA TN - TENNESSEE TX - TEXAS UT - UTAH VA - VIRGINIA VI - VIRGIN ISLANDS VT - VERMONT WA - WASHINGTON WI - WISCONSIN WV - WEST VIRGINA WY - WYOMING Zip /Postal Code: Country: USA Albania Algeria American Samoa Andorra Angola Anguilla Antarctica Antigua And Barbuda Argentina Armenia Aruba Australia Austria Azerbaijan Bahamas Bahrain Bangladesh Barbados Belarus Belgium Belize Benin Bermuda Bhutan Bolivia Bosnia and Herzegowina Botswana Bouvet Island Brazil British Indian Ocean Territory Brunei Darussalam Bulgaria Burkina Faso Burma Burundi Cambodia Cameroon Canada Cape Verde Cayman Islands Central African Republic Chad Chile China Christmas Island Cocos (Keeling) Islands Colombia Comoros Congo Congo, the Democratic Republic of the Cook Islands Costa Rica Cote d'Ivoire Croatia Cyprus Czech Republic Denmark Djibouti Dominica Dominican Republic East Timor Ecuador Egypt El Salvador England Equatorial Guinea Eritrea Espana Estonia Ethiopia Falkland Islands Faroe Islands Fiji Finland France French Guiana French Polynesia French Southern Territories Gabon Gambia Georgia Germany Ghana Gibraltar Great Britain Greece Greenland Grenada Guadeloupe Guam Guatemala Guinea Guinea-Bissau Guyana Haiti Heard and Mc Donald Islands Honduras Hong Kong Hungary Iceland India Indonesia Ireland Israel Italy Jamaica Japan Jordan Kazakhstan Kenya Kiribati Korea, Republic of Korea (South) Kuwait Kyrgyzstan Lao People's Democratic Republic Latvia Lebanon Lesotho Liberia Liechtenstein Lithuania Luxembourg Macau Macedonia Madagascar Malawi Malaysia Maldives Mali Malta Marshall Islands Martinique Mauritania Mauritius Mayotte Mexico Micronesia, Federated States of Moldova, Republic of Monaco Mongolia Montserrat Morocco Mozambique Myanmar Namibia Nauru Nepal Netherlands Netherlands Antilles New Caledonia New Zealand Nicaragua Niger Nigeria Niue Norfolk Island Northern Ireland Northern Mariana Islands Norway Oman Pakistan Palau Panama Papua New Guinea Paraguay Peru Philippines Pitcairn Poland Portugal Puerto Rico Qatar Reunion Romania Russia Russian Federation Rwanda Saint Kitts and Nevis Saint Lucia Saint Vincent and the Grenadines Samoa (Independent) San Marino Sao Tome and Principe Saudi Arabia Scotland Senegal Seychelles Sierra Leone Singapore Slovakia Slovenia Solomon Islands Somalia South Africa South Georgia and the South Sandwich Islands South Korea Spain Sri Lanka St. Helena St. Pierre and Miquelon Suriname Svalbard and Jan Mayen Islands Swaziland Sweden Switzerland Taiwan Tajikistan Tanzania Thailand Togo Tokelau Tonga Trinidad Trinidad and Tobago Tunisia Turkey Turkmenistan Turks and Caicos Islands Tuvalu Uganda Ukraine United Arab Emirates United Kingdom United States United States Minor Outlying Islands Uruguay Uzbekistan Vanuatu Venezuela Viet Nam Virgin Islands (British) Virgin Islands (U.S.) Wales Wallis and Futuna Islands Western Sahara Yemen Zambia Zimbabwe Phone Number:    Miscellaneous Description: Sunday Morning Worship:  H 1 2 3 4 5 6 7 8 9 10 11 12   M :00 AM :15 AM :30 AM :45 AM :00 PM :15 PM :30 PM :45 PM Sunday Morning Comments: Sunday Evening Worship:  H N/A 1 2 3 4 5 6 7 8 9 10 11 12 M N/A :00 AM :15 AM :30 AM :45 AM :00 PM :15 PM :30 PM :45 PM Sunday Evening Comments: Mid Week Worship:  D N/A Mon Tue Wed Thu Fri H N/A 1 2 3 4 5 6 7 8 9 10 11 12 M N/A :00 AM :15 AM :30 AM :45 AM :00 PM :15 PM :30 PM :45 PM Mid Week Comments: Directions: Congregational Members 2 to 5 6 to 10 11 to 15 16 to 20 21 to 25 26 to 30 30 to 40 41 to 50 51 to 60 61 to 75 76 to 100 101 to 125 126 to 150 151 to 200 More than 200 Elders in Congregation 0 2 3 4 5 6 7 More than 7 Teachers in Congregation 0 to 1 2 to 5 6 to 10 11 to 15 16 to 20 More than 20 Men in Congregation 2 to 5 6 to 10 11 to 15 16 to 20 21 to 25 26 to 30 31 to 40 41 to 50 51 to 60 61 to 75 76 to 100 More than 100 Women in Congregation 2 to 5 6 to 10 11 to 15 16 to 20 21 to 25 26 to 30 31 to 40 41 to 50 51 to 60 61 to 75 76 to 100 More than 100 Children in Congregation 2 to 5 6 to 10 11 to 15 16 to 20 21 to 25 26 to 30 31 to 40 41 to 50 51 to 60 61 to 75 76 to 100 101 to 125 126 to 150 More than 150 History of this Congregation:
Reference # 1	A Christian who can confirm your 's and your congregation's stand
Phn or Email #1 (Either/OR)	Email
Reference # 2	A Christian who can confirm your 's and your congregation's stand
Phn or Email #2 (Either/OR)	Email
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YES  NO	Please send me Email notices of Prayer Requests, Events, Disasters & Needs in the Brotherhood, etc.
YES  NO	Please send my spouse Email notices of Prayer Requests, Events, Disasters & Needs in the Brotherhood, etc.
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Average weekly amount of time you work as an evangelist:
        0 to 6 hours 7 to 14 hours 15 to 25 hours 26 to 39 hours 40 to 50 hours Over 50 hours Choose from drop down list
            Additional work time information:
               

Previously a member of:
        Other Assemblies of God Baptist Jehovah Witness Jewish Lutheran Methodist Mormon Multiple Cups Non-member Orthodox Presbyterian Roman Catholic
            Preacher's additional religious history:
               

Evangelistic Goals:
            What are your preaching goals?
            If you plan on preaching in places other than your local congregation...
                How will your home congregation have services when you are gone?
               

Educational Background
            Schooling? College? Seminary? Other?
               

Income Requirements:  (optional ~ not needed if you are not in need of financial support)
            Please give information on previous income amounts received and from whom.
            Please give information on income you are now receiving.
                (both from preaching and non-preaching work)
           

Family Information:
            Here you can include any family info that you would like to list.
                (Children's names, other family members living with you, etc.)
           

Enter any additional comments in the space provided below: