Membership Form

First Name:

Last Name:

Birthday:

Gender Male Female

Street Address 1

Street Address 2:

City:

State: AL AK AZ AR CA CO CT DC DE FL GA HI IA ID IL IN KS KY LA MA MD ME MI MN MS MO MT NE NV NH NJ NM NY NC ND OH OK OR PA RI SC SD TN TX UT VT VA WA WV WI WY

Zip Code:

Email Address:

Confirm Email Address:

Home Phone: e.g. (123) 456-7890

Cell Phone:

Work Phone:

Fax:

Name of your Pastor:

Church name:

Street Address 1

Street Address 2:

City:

State: AL AK AZ AR CA CO CT DC DE FL GA HI IA ID IL IN KS KY LA MA MD ME MI MN MS MO MT NE NV NH NJ NM NY NC ND OH OK OR PA RI SC SD TN TX UT VT VA WA WV WI WY

Zip Code:

Phone Number:

Are you marrie d?  Yes     No

Spouses Name:

Wedding Date: (mm/dd/yyyy)

Number of Dependents:

Dependents Name:

Dependents Birthdate: (mm/dd/yyyy)

Dependents Name:

Dependents Birthdate: (mm/dd/yyyy)

Dependents Name:

Dependents Birthdate: (mm/dd/yyyy)

Is your spouse in agreement with your desire to become a part of WME?

*Have you been divorced?  Yes     No How long?

Have you been remarried?  Yes     No How long?

Have your spouse been divorced?  Yes     No How long?

Comments on the above if answered yes.

Have you been ordained?  Yes     No Ordained By:

Date: (mm/dd/yyyy)

Name of organization:

Street Address 1

Street Address 2:

City:

State: AL AK AZ AR CA CO CT DC DE FL GA HI IA ID IL IN KS KY LA MA MD ME MI MN MS MO MT NE NV NH NJ NM NY NC ND OH OK OR PA RI SC SD TN TX UT VT VA WA WV WI WY

Zip Code:

What calling in ministry are you presently following?

List Spiritual Gifts, Skills & Talents:

Organization 1 Ph:

Organization 2 Ph:

Name of Organization 3 Ph:

Please check the license you desire with WME.  Ordination    License    Christian Worker

Are you willing to abide by the rules and by-laws of WME?  Yes     No

Briefly describe why you would like to be a member of WME?