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Member Benvolence Form
Linda Burnett
2020-08-21T11:21:31-05:00
Member Benevolence Form
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Member Contact Information
Name
*
First
Last
Address
Address Line 1
Address Line 2
City
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
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South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
State
Zip Code
Phone
*
Email
*
Member Employment Information
Are you employed?
Yes
No
Place of employment
Supervisor Name
First
Last
Supervisor's Phone Number
Member Worship and Ministry Information
How long have you been a member?
<1 year
1-4 years
5+ years
Which service do you often attend?
7:45am
10:45am
Do you serve in ministry
Yes
No
Please provide the name of the ministry
Are you an active financial supporter?
Yes
No
Benevolence Requested
Please included copies of bills to be considered for assistance
Bill #1 in $
Bill copy upload
Click or drag a file to this area to upload.
Bill #2 in $
Bill copy upload
Click or drag a file to this area to upload.
Bill #3 in $
Bill copy upload
Click or drag a file to this area to upload.
Have you ever received benevolence from First Metropolitan Church?
Yes
No
Amount in $
Reason
Will you be able to pay back the benevolence?
Yes
No
Website
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