License Ordination   Type of Renewal                                               Name (as you want it to appear on your credential card)  Address          Apt.   City                State/Province  Country         Zip Code  Home Phone   Fax Email address                       Date of Birth (Month/Day/Year)   

Single Married Widowed Separated Divorced Marital Status  Spouse' s Name 0 1 2 3 4 5 6 7 8 9 10 more than 10 Number of children, including those not at home

Description of Your Present Ministry:

1.  How much time do you give to your present ministry

Full Time     1-2 days a week     3-4 days a week 

5-6 days a week     Less than 1 day a week

2.  If a staff member, name of church and location

3.  Are you secularly employed? Yes No   If yes, where?    Hours per week?

4.  Do you consistently abide by the Covenant of Conduct of CMN? Yes No                                    If No, please explain.

5.  Do you fully subscribe to the Statement of Faith? Yes No                                                       If No, please explain.

My renewal fees have been Sent to CMN   Paid online.