Name *

First

Last

Spouse Name

First

Last

Designation

Email *

Telephone *

Name of Church / Ministry / Business / Industry *

Your Birthday

Designation:

• Founder/ General Overseer / Senior Pastor
• Assistant / Associate Pastor
• Head of Department
• Team Leader
• Market Place Priest (President, CEO, COO, Manager, etc.)
• Other

Other

Are you a Full-time Pastor?

• Yes
• No

Other (copy)

Ministerial qualification(s)

Non ministerial qualification(s):

• OND
• HND
• First Degree
• Second Degree
• MBA
• Doctorate

Family Data

Spouse Name *

First

Last

Spouse's Birthday

Wedding Anniversary

Number of Children

Church/Ministry/Organization Data

Church / Ministry / Organization Name

Venue

City

State

Country

Office Phone

Cell Phone

Email

Website

Your Church / Organization Anniversary (MM/DD/YY)

Years in Existence

Size of Membership

Number of Branch(es), If Any

Number of Church / Organisation Staff

How Many in Leadership

Denominational Affiliation

Is your Church/ Organization Registered with Corporate Affairs Commission?

• Yes
• No

If Yes, Please Include RC Number

Do you have a Church / Ministry / Organization Bank Account?

• Yes
• No

Contact Person in Your Office

Contact Person Title

Contact Person Work Phone

Contact Person Alternate Phone

Contact Person E-mail

Office Hours

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