Credentials Application (NEW)

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Name of Applicant

*

Current Credential

*

Please select one option.

Bishop Brotherhood Deacon(ess) District Elder Elder Evangelist/Prophet Licensed Minister Minister-In-Training Missionary(Junior) Missionary(Senior) Missionary(Social) Nurse Pastor Security Sunday School Usher Women's Fellowship Youth

New Credential

Bishops Initial Credential ($300) Brotherhood ($20) Deacon/Deaconess ($25) District Elder ($150) Elder ($75) Evangelist/Prophet(ess) ($75) Licensed Ministers ($50) Minister in Training ($25) Missionary/Field ($50) Missionary/Senior ($35) Missionary/Social ($25) Missionary/Junior ($20) Nurses ($20) Pastor ($100) Security ($20) Sunday School ($20) Ushers ($20) Women's Fellowship ($20) Young Adults ($20) Youth ($10) Multiple Credentials

Amount

Applicant's Email

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This address will receive a confirmation email

Applicant's Home Address

*

Telephone Number

*

Date of Birth

*

Marital Status

*

Please select one option.

Single Married Widowed Separated Divorced

Have you been Baptized In Jesus Name

*

Please select one option.

Yes No

Have you received the Baptism of the Holy Ghost

*

Please select one option.

Yes No

Below you will complete the following as instructed:

- DO NOT abbreviate or shorten your church name, address, pastors name or diocese.
- When entering pastor's name please be sure to include clerical title (ex: Bishop John Doe II)

Church Name

*

Church Address

*

Pastor's Name

*

Diocese

*

Picture Attachments

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Credit/Debit Card Number

Expiration Date/CVC

Name on Card

Card Billing Address

Description

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