Welcome to the NC State Council

APPLICATION FOR CHURCH AFFILIATION

NC STATE COUNCIL

58TH EPISCOPAL DISTRICT

OF THE PENTECOSTAL ASSEMBLIES OF THE WORLD, INC.

Dr. Marion E. Wright, Sr., Diocesan

Please complete the following Church Affiliation Form and a representative from our Board will connect with you to review the details of your application and discuss next steps.

Church Mailing Address
Church Mailing Address
Phone
Phone
FAX
FAX
Church Start Date
Church Start Date
Name *
Name
Present Facility Address
Present Facility Address
Name of Pastor
Name of Pastor
Pastor's Address
Pastor's Address
Pastor's Phone/ Cell
Pastor's Phone/ Cell
Date Ordained / Licensed
Date Ordained / Licensed
Highest Level of Education
Spouse Name
Spouse Name