PASTOL NG PANGINOON MORAL AND SPIRITUAL TRANSFORMATION

Contact: 09085000092/09481580281 Main Office: Evangelical Worship Center, Gate 3, Camp Crame, Quezon City SEC. REG. CN200502441

New Membership

Renewal

Support Member/Staff

MEMBERSHIP FORM
NOTE: Please write your name in the clearest & readable way. Rest assured that information provided here will be treated confidentially.

_______________________, _______________________ ____________________ _____

FAMILY NAME FIRST NAME MIDDLE NAME
NAME EXTENCION

ADDRESS: CONTACT #: DATE OF BIRTH: ENDORSED BY:

MONTH DAY YEAR

Contact #:

Please write your Signature 3 times:

2x2 LATEST PICURE

Please provided the following requirements as you submit this form: 1. Proof/s and certification that applicant is a Pastor or church worker. 2. Photocopy of CEDULA 3. 2x2 I.D. Picture (2 Pcs.)
CMF0876621001201

(Pastors License or Certification from the church by church leader, elders and/or officers)

I. GENERAL INFORMATION Name: Gender: Place of Birth: Residential Address: Mobile No.: Spouse Name:

Civil Status: Date of Birth: E-mail Address: Contact #:

II. MINISTERIAL INFORMATION Name of Denomination: Name of Church: Church Address: Church Position: Years in Service: Ministerial Experience/s: _____________________________________________________________________ _____________________________________________________________________ _____________________________________________________________________ _____________________________________________________________________ III. HIGHEST EDUCATIONAL ATTAINMENT Course School Name & Address

Year

IV.

OTHER TITLES EARNED (Optional) Title/Position

Year

V.

TERMS AND AGREEMENT

I declare under oath that this Personal Date Sheet has been accomplished by me, and is true, correct and done in good faith; That I do solemnly swear that I will faithfully abide with all existing rules and regulations set by the Philippine Constitution and by the PNP-MOST; That I will support the PNP-MOST Vision and Mission; That I am willing to become agent of Values Transformation and Spiritual Revival in the PNP Organization, Government Offices and in our Society; That I am liable for all actions taken against me if there is an administrative case/criminal case filed against me while I am still an active member of PNP-MOST. That most of all, committed to God, I will witness for Him in ways possible.

_______________________ Date Completed & Submitted:

______________________________________________ SIGNATURE OVER PRINTER NAME:

CMF0876621001201