Registered Chaplain Membership Renewal Form

Documents will be sent to the address you list below, please make sure you list the address where you want your documents to be sent. Renewal application cannot be sent by fax or e-mail.

Name: ____________________________________________________ Date: ________________

Address: ________________________________________________________________________

City: ____________________________ State: _______________ Zip Code:__________________

Home Phone (____) _______________________ Business Phone (___)_____________________

E-mail Address: __________________________________________________________________

Hair Color: ____________ Eye Color: __________ Height: __________ Weight: ______________

I have been a member Since: Date: __________________________________________________

My member's ID Card Number is: ___________________________________________________

My membership expires or expired on: _______________________________________________

In Case of an emergency notify: ____________________________________________________

Relationship _______________________________ Phone: ______________________________

Chaplain Fellowship Ministries Holds all Members Accountable For Their Actions - Without Accountability There Is No Credibility

Have you ever been arrested or charged with a crime within the past twelve months? [ ] Yes [ ] No -If yes please explain on the back of the application. We are very understanding, many of us have been broken and have had our own problems. That is why most of us know what it means to say we walk the walk!

No Application for renewal will be processed without all required information being completed. Make sure you read this carefully before signing. No application for renewal of membership, license or endorsement will be considered or processed without this application being completed in full, signed and dated.

There are two ways members can receive automatic membership renewal each year!

1. Member's who recruits five new members in any one twelve month period will be automatically renewed that year. It is the member's responsibility to keep track of the new members they recruit and submit their names at the time of their membership renewal. All members of Chaplain Fellowship Ministries are expected to recruit new members thereby acknowledging that no faith based institution or ministry can stand or be of full service unless all members accept some responsibility for the welfare of the ministry.

2. Member's who make a pledge of $25.00 a month for the stability and advancement of Chaplain Fellowship Ministries and keep their commitment will have their membership automatically renewed each year. Member's records are checked and verified at time renewal request is received.

Registered chaplain membership renewal: For the initial donation of $60.00 to cover document production mailing cost and recording of all documents registered chaplains will be renewed. Send your renewal and donation to the address listed below.

1. This year I am making a monthly financial commitment of at least ____ $10.00 ____$15.00 ___ $25.00 ___ $45.00 ___ $65.00 ___ $75.00 ___ $100.00 ___ $200.00 ___ $300.00 ___ $400.00 ___ $500.00 for the stability and future advancement of Chaplain Fellowship Ministries.

2. I can not make a monthly commitment for the stability and advancement of Chaplain Fellowship Ministries. I am making a one time donation of $15.00 ___ $25.00 ___ $45.00 ___ $55.00 ___ $65.00 ___ $75.00 ___ $100.00 ___ $200.00 ___ $300.00 ___ $400.00 ___ $500.00 ____ for the stability and advancement of Chaplain Fellowship Ministries.

I hereby certify that the above information is true to the best of my knowledge. I understand that Chaplain Fellowship Ministries will be relying upon this information to grant me approval regarding my membership renewal. I acknowledge that any false information provided by me will be just cause to deny renewal of my membership. Should any of my responses to these statements change I will immediately notify the home office of Chaplain Fellowship Ministries.

Signature Required: __________________________________________ Date: ________________

1. Checks or Money Orders: All donations must be in US funds. Make payable to: Chaplain Fellowship Ministries, Mail your completed renewal application with your check or money order to the address listed below. Renewal membership packages may take up to 2 to 3 weeks for delivery once received in our office.

2. Major credit cards are accepted: You can make your donation using your major credit card by clicking on the add to cart button below. Mail your completed application to the address at the top of this application after making your donation. Renewal membership packages may take up to 2 to 3 weeks for delivery once received in our office.

Please Note: Unscriptural conduct or failure to maintain membership requirements in good standing or doctrinal departure from the tenets of faith shall be considered sufficient Grounds upon which any person may be disqualified and removed from membership. The requirements and information required within this application shall be subject to change without notice. The board of directors does hereby have the right to refuse membership renewal for Unscriptural conduct or failure to maintain membership requirements in good standing. All decisions made by the board of directors are final and binding. No goods or services were provided for donations other than intangible religious benefits.