Stand In The Gap Ministries


WIDOWS PARTNER APPLICATION
Today's Date: *

CHURCH OR ORGANIZATION INFORMATION
Church or Organization Name *
Church Campus, if applicable
Address 1 *
Address 2
City *
State *
Zip *
Phone *
Email *
Pastor's Name *
Pastor's Contact Number
Age of Church/Organization
Approximate # of Attenders
* * * * *
PRIMARY CONTACT'S INFORMATION
Primary's First Name *
Primary's Last Name *
Primary's Email *
Primary's Cell Phone *
Primary's Gender *
Primary's Birthdate *
(Primary) Are you widowed? *
(Primary) How long have you attended this church/organization? *

SECONDARY CONTACT (Must be associated with this organization)
Secondary's First Name
Secondary's Last Name
Secondary's Email
Secondary's Cell Phone
Secondary's Gender
Secondary's Birthdate
(Secondary) Are you widowed?
(Secondary) How long have you been attending this church/organization?

Neon CRM by Neon One

WIDOWS PARTNER APPLICATION