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Application for Membership Affiliation
Apostolic Headquarters
c/o TRIEDSTONE BAPTIST CHURCH
858 East Third Avenue – Columbus, Ohio 43201
(614) 424-6976 Office
dreid@kingdomconnectionfellowship.org
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* Indicates required question
First Name
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Your answer
Middle Name
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Your answer
Last Name
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Your answer
Maiden Name (If Applicable)
Your answer
Home Address
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City
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Your answer
State/Providence
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Country
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Your answer
Zip Code
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Your answer
Personal Email Address
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Home Phone Number
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Home Fax Number
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Cell Phone Number
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Business/ Other (please specify)
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Your answer
Date of Birth
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MM
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DD
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YYYY
Gender
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Male
Femail
Marital Status
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Married
Single
Divorced
Seperated
Widowed
Is your spouse in ministry?
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Yes
No
Are you the Senior Pastor of your church?
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Yes
No
Name of Church
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Your answer
Street Address
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City
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Your answer
State/Providence
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Country
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Zip
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Mailing Address (if different)
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Office Email Address
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Church Website Address
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Executive Admin/ Assistant
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Assistant’s Cell Number
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Date you accepted call to ministry
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MM
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DD
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YYYY
Date ordained
MM
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DD
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Full Name of Ordaining Pastor/Name of Church and Address
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Name of fellowship, organization, and/or denomination in which you were ordained
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Are you a duly consecrated bishop?
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Yes
No
If no, briefly explain below how you came to assume the title.
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If Yes, indicate date of Consecration
MM
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DD
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YYYY
Name of Organization and Address
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Chief Consecrator's full name, chuch, phone, and email address.
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What is your highest level of education obtained:
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High School
College
Graduate
Dorctorate
Seminary/Bible College
**Did you earn a degree or certificate?
Degree
Certificate
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Name of Degree/Certificate(s) **Please submit copies of your ordination and consecration certificates with this application via fax 614-299-2469 within 48-72 hours after completion. Thank you.
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Please submit your name as an electronic signature
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