EmailMe Form - International Federation of Christian Chaplains

EmailMeForm

PERSONAL INFORMATION:
First and last name: * *
Title (check all that apply):
Rev.
Pastor
Dr.
Bishop
Apostle
Leader
Minister
Deacon / Elder
Evangelist
Other
Email *

Confirm Email
Web Site
Your Facebook Page Link:
Address:
(Please provide the appropriate address where your certification documents will arrive safely)

Street Address City State / Province / Region Postal / Zip Code Country / Region
Cellular Phone:
We may send you text o voice mail messages.
### - ### - ####
MINISTERIAL INFORMATION:
Church or Ministry name
Give us a brief description of your Ministry and/or Chaplain Vision, etc. (Please do not just write three words..., we need to know about your ministry and God given call in order to "Certify You" through life experience justification). * *
LEGAL INFORMATION:
Do you have any unresolved problems with the law?
Have you abused of any forbidden narcotics before?
Have you abused of other people before (physically or mentally, etc.)?
OTHER INFORMATION:
How long have you known Dr. Vargas?
How did you hear about us (The International Federation of Christian Chaplains?
Evaluate the following statements. *

Strongly Disagree Disagree Agree Strongly Agree N/A

I am a born again Christian

I will pay the application, credential and certification fees, immediately after approval
I understand that this information is true to the best of my knowledge, as a testimony and confirmation I include today's date and time:
MM / DD / YYYY
---> Paying now will rush your application.
---> In the rare event that you are not accepted, money will be 100% refunded.
---> If you have already paid, please disregard this message.
---> If you prefer to pay later, you may also do that. Amen.
$ Dollars . Cents
---> If you prefer, you can make 3 monthly payments.
---> In the rare event that you are not accepted, money will be 100% refunded.
---> If you have already paid, please disregard this message.
---> If you prefer to pay later, you may also do that. Amen.
$ Dollars . Cents
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	Strongly Disagree	Disagree	Agree	Strongly Agree	N/A
I am a born again Christian
I will pay the application, credential and certification fees, immediately after approval

PERSONAL INFORMATION:

MINISTERIAL INFORMATION:

LEGAL INFORMATION:

OTHER INFORMATION: