Men’s Ministry and Fellowship Report Form

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Date: *

Name of Church *

Pastor's Name *

Church Address *

Address Line 1

Address Line 2

City

--- Select state ---AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingState

Zip Code

Please Select Region *

• Northern Region
• Southern Region

IS CHURCH MAILING ADDRESS SAME AS ABOVE? *

• YES
• NO

Church Mailing Address

Address Line 1

Address Line 2

City

--- Select state ---AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingState

Zip Code

Local President's Name *

Local President's Email

District Leader's Name

Membership Selection *

• 01 - 25 Membership ($50.00)
• 26 - 50 Membership ($75.00)
• 51 plus ($100.00)

Local President's Report

• Local President's Report ($50.00)

Total

$0.00

Please Select Method of Payment *

• Credit/Debit
• PayPal

Stripe Credit Card *

Card

Name on Card

Name

Submit

PRESIDENT: ELDER JAMES FOSTER

VICE-PRESIDENT: ELDER EDWARD YOUNG

SECRETARY: BROTHER RONALD HENDERSON

DIOCESAN BISHOP: THE HONORABLE BISHOP JOSEPH D. GUTHRIE

www.gastatecouncil.com