Full Legal Name
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First Name
Last Name
Name as it should appear on my 2026 Standing:
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Primary Phone Number
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(###)
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Secondary Phone Number, if any
(###)
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Email
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Address
Address 1
Address 2
City
State/Province
Zip/Postal Code
Country
Would you consider yourself a bi-vocational minister (serve more than 1 location)?
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What is your age?
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What is your ministry location? (full address)
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Name of Congregation/Institution you serve:
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Address of Congregation/Institution you serve:
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Congregation/Institution Website:
Please send mail to:
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In the Christian Church (Disciples of Christ) in Alabama NW Florida, I serve as:
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Christian Church (Disciples of Christ) Ordination Region and Date:
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Ordained by another denomination (specify denomination)
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Ordination recognized and Standing certified on (date):
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Ordination recognized and Standing certified by:
My last training for Healthy Boundaries for Clergy was: (provide location and date)
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My last training for Diversity and/or Anti-Racism Training was: (provide location and date)
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List other trainings/certifications you have received in the past year:
I currently serve as (as designated by GCOM; if serving in multiple ministerial positions, select primary one for reporting to Yearbook):
( If you checked RETIRED INACTIVE, skip to the end, sign, and date)
The Christian Church (Disciples of Christ) seeks to be a pro-reconciling/anti-racist church. To that end, we seek to maintain an understanding of the diversity of the servants who are leading the church in various Ministries. Please make the ethnicity choice(s) appropriate to you:
I have reviewed and will adhere to the Ministerial Code of Ethics of the Christian Church (Disciples of Christ)
I will be a faithful Minister serving within and supportive of the Christian Church (Disciples of Christ)
In the past year, I have participated in: (Check all that apply)
Passions/Demonstrated Experience:
Are there other ideas/ways in which you believe would strengthen the Region or service churches/clergy better?
Are there other ideas/ways in which you believe would strengthen the Region or service churches/clergy better?
I am a member of (Congregation and Location):
SIGNATURE
First Name
Last Name
Date
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