Membership Application

Prefix

First Name

Middle Name

Last Name

Date of Birth

Cell Phone

Email Address

Spouse Name

Spouse Date of Birth

Street Address

Apartment, suite, etc

City

State/Province

ZIP / Postal Code

Spouse Cell Phone

Spouse Email Address

Pastor NamePastor or COM name reference

Pastor Phone

Name of Church MembershipName of church and demonination

Church Phone

Street Address

City

State/Province

ZIP / Postal Code

Check type of projects in which you have participated

COMNAMBIMBLocal Church ProjectState ConventionOtherHave you participated in a mission project.

List Areas Of Special Training

Campground MinistriesChurch PlantingConstruction / MaintanceDisaster Relief / RecoveryFairs, Festivals, Special EventsCommunity Survey, RevivalsPersonal TestimonyState Convention BoothsVBS, Bible StudyClowns, FacepaintingRaceway MinistriesSeaman’s MinistriesOther

Emergency Contact NamePerson to contact if you are not able to communicate.

Emergency Contact Phone

Campers On Mission Statement of Faith

SignatureBy typing my name in the signature box, I agree with COM Statement of Faith and will endeavor to live my life guided by the scripture it is based on.

Spouse SignatureBy typing my name in the signature box, I agree with COM Statement of Faith and will endeavor to live my life guided by the scripture it is based on.

Date Signed and Submitted

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