Minister Information Form

First Name*
Last Name*
Spouse Name
Street Address*
City*
State*
Zip Code*
Home Phone
Office Phone
Cell Phone
Cell Phone
Cell phone will be printed in NCP directory unless you indicate unlisted
Preferred Email*
Date of Birth*

01-01-2021 (ex) *the actual date of birth will be used for internal purposes only and will not be published in NCP's directory.
Date of Ordination*

01-01-2021 (ex)
Date of Installation

01-01-2021 (ex)
Serve as Pulpit Supply
- Yes
- No
(for Specialized or Member-at Large only)
Check all that apply
- comfortable with live streaming
- comfortable with zoom
- comfortable with facebook live