LIVING IN DELIVERANCE INTERNATIONAL MINISTRY
MENMBERSHIP INFORMATION FORM/INDIVIDUAL
Please take a few minutes to fill out this form.
For Individual membership, please use the Individual Membership Application Form.
Your participation will help to keep our Organization active– and you’ll find that Organization is more
interesting when you’re involved. As you see, time commitments can be brief, moderate, or
lasting, so we hope you’ll let us know what you would like to do.
Name First :______________________________________Last Name: ____________________
Gender Female ( ) Male ( )
Street Address:
City, State, Zip:
Telephone: (home) (work)
Cell Phone: E-Mail
Please check the following ways you would be willing to participate in the Organization this year:
􀂉 Attend monthly meetings (program presented)
􀂉 Make telephone calls for meetings and other activities
􀂉 Committee member (Circle ones of interest)
Natural Resources like Researches
International Issues Health Care support
Social work for Men/Women’s Issues
􀂉 Board member (position)
􀂉 A participant in a Kid Club and Youth Program (Circle One that fit you)
􀂉 Letter writing to Local and International Agencies
􀂉 Grant Writer services
􀂉 Refreshments for meetings
􀂉 Donate home for meetings
􀂉 Could we call you if we need help with specific activity? (For example: new member orientation, holiday party, annual meeting, fundraiser, yes/no
(other) Specify
􀂉 Mentor for new members
􀂉 Recruit new members
􀂉 Finance drive
What special skills or experience can you bring to the Organization?
Do you know someone who would like to join our Organization? (friends, acquaintances, relatives)
Name:
Address
Telephone_____________________Email __________________________
Please return this completed form to Membership Chair
Your name: First Name______________________MI____ Last Name________________-
Comments: Please tell us about yourself be specific please
________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________
Print Name:________________________________________
Applicant Signature date_____________
Membership in this organization is open to all persons, regardless of race, color, religion, sex, national origin, handicap or familial status
BUT WE RESERVED THE RIGHTS TO TERMINATE OR DISQUALIFY ANY FALSE OR MISCONDUCT APPLICANTS
Please Read and Initial Revised April 2012
