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First Name:
Middle Name:
Last Name:
Preferred Name:
Birthdate:
(x/x/xxxx)
Birthplace:
Race/Ethnicity:
White non-Hispanic (Anglo)
Hispanic
Black non-Hispanic
(African-American)
Native American
Asian or Pacific Islander
Other
Special Communities:
Deaf
Blind
Mute
U.S. Citizen:
Yes
No
Canadian Citizen:
Yes
No
If naturalized, when and where:
Immigration status and number:
Date of entry into US/Canada:
(x/x/xxxx)
Address:
(residence)
City:
State/Province:
Zip:
Email:
Phone:
(include area code)
Marital Status:
(choose one)
Single
Engaged
Married
Divorced
Widowed
Remarried
Age and place of conversion:
Briefly describe your conversion:
Age and place of call to church planting:
Briefly describe your call:
I am interested in being a part of a church planting team:
Yes
No
List your three ministry positions:
Position 1:
Title:
Description:
Date started:
(x/x/xxxx)
Date ended:
(x/x/xxxx)
Position 2:
Title:
Description:
Date started:
(x/x/xxxx)
Date ended:
(x/x/xxxx)
Position 3:
Title:
Description:
Date started:
(x/x/xxxx)
Date ended:
(x/x/xxxx)
Formal education and training:
College degree:
From:
(x/x/xxxx)
To:
(x/x/xxxx)
Graduate degree:
From:
(x/x/xxxx)
To:
(x/x/xxxx)
Indicate any geographic preference you have for church planting
(click all that apply):
Canada (province)
United States:
Northeast
North Central
Northwest
Midwest
Southeast
Alaska
Southwest
Hawaii
Puerto Rico
I grant NAMB permission to give this information to Canadian and state convention leaders who are looking for new church planters:
Yes
No
For more information contact:
Russell Begaye
Planter Recruitment Manager
4200 North Point Parkway
Alpharetta, GA 30022-4176
770-410-6236
rbegaye@namb.net
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