PA Conference of IPHC / Info / Info

Please give us as much information as possible. For married couples, please fill out seperate forms if both spouses carry credentials with the ROL Conference

First Name

Last Name

Type of Credentials

Select One

LCM - Local Church Minister

LM - Licensed Minister

OM - Ordained Minister

MUS - Minister of Music

EV - Evangelist

MIS - Missionary

Your contact info:

Email Address

Phone Number

Church Number

What is the best way to reach you?

Email

Phone

Text

Please enter your full address:

Street Address

City

State

Zip Code

PERSONAL INFORMATION

Birthday

Anniversary

CHURCH INFORMATION

Church Name

Church Address

City

State

Zip

Additional Information

RIver of Life Ministers Information