Contact Person Name *

First Name

Last Name

Address *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Phone *

(###)

###

####

Is This Church Already Functioning? *

Yes

No

Has This Church Currently Or In The Past Been Affiliated With A Denomination Or Network? *

Yes

No

What Type Of Ministry Is This Church? *

Association

Mother/Daughter Work

Individual Initative

Do You Have A Financial Statement, Annual Report Or Constitution Available? *

Yes

No

What Type Of Church Is It To Be? *

Traditional

Contemporary

Missional Community

Satellite

Cell

Other

Do You Have A Financial Plan In Place? *

Yes

No

Are You Willing To Follow The Rules And Guidelines Set For Church Plants? *

Yes

No

Date *

MM

DD

YYYY