IBW Consolidated Assessment Report

Date

Please Select One

Bishop District Elder

Church Information

Church's Name

Address

Church Phone

Church Email

This address will receive a confirmation email

Name of Bishop/District Elder

Mailing Address

This address will receive a confirmation email

Cell Phone

Diocese Information

Diocese Name

Name of Diocesan

Consolidated Assessment

Executive Board - $1,200 * General Board - $1,000 * District Elder - $700

Assessment

Christian Education ($5 per member)

Clergy Wives $25 Representation

Deacons $25 Representation

IYPU ($2 per member)

Men $50 Representation

Missionary $25 Representation

Women $50 Representation

Ushers $25 Representation

Credit/Debit Card Number

Expiration Date/CVC

Name on Card Card Billing Address

Description

Please complete and submit the form along with your Annual Church Report credit card payment.