Name*

Prefix First Last

Role:*

Which Committee do you serve on?

Which Team do you serve on?

Other:

Home Address:*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code

Photo

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Cell number:*

How would you like this information to be kept?*

Email:*

How would you like this information to be kept?*

Office Address:

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code

How would you like this information to be kept?*

Office Phone Number:*

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Social Media Profile Links:

Facebook:

Twitter:

LinkedIn:

Instagram:

Other Social Media links, please list here:

How would you like this information to be kept?*

Social Media Links to publish in the online Pastor Directory:

Presbytery Meeting