District Ministerial License Transfer

 

Name *
First Name
Middle
Last Name
Phone Number (cell number preferable)*
Email*
Home Address *
Address Line 1
Address Line 2
City
State/Prov.
Postal Code
Credential*
Year Issued (District Name)*
Role Code*
Transferring to which district?*
Former Church Name*
New Church Name*
Please initial this box to verify all information is correct.*
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