Is this a new entry or a change of information for our database?

New Entry
Change of Information
 

Please provide the following contact information:

	* =required
First Name
Last Name
Leaders Name:
Organization
*Mailing Address
Street Address:
Address (cont.)
*City
*State/Province
*Zip/Postal Code
*Country
Work Phone
Home Phone
*note:	hm ph not be displayed in directory, for contact purposes only
Mobile Phone
FAX
E-mail
Alt Email:
URL

Do you currently reside on a reservation?

Yes        No

If "YES" to the question above, which reservation are you residing on?

Are you associated with any other reservations?

Yes       No

If "YES" to the question above, please list any reservations you are associated with...

What type of organization is your ministry?

Not Applicable Church Dance/Drama Drum Groups In Home Fellowship Ministry Music Ministry Prayer/Prophecy Network Radio/TV School

Please submit a mission statement of this organization/ministry:

*Please submit one reference of a pastor or leader for reference only-will not be displayed in directory

*Pastor/Leaders/Elders Name:

*Pastor/Leader's/Elders Contact Phone Number: w/ area code

Comments?  Feel free to communicate any information to us, as we would like to be in communication with you.  This will not be posted in our directory.  Thank you.