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2023 Mid-Atlantic Youth Camp Staff Application
Church of God of Prophecy Mid-Atlantic Regional Ministries Event Staff Applicant Information (must be 18 or older)
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Email
*
Your email
First Name
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Your answer
Last Name
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Your answer
Middle Name
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Your answer
Birth Date:
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MM
/
DD
/
YYYY
Street Address
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Your answer
City
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Your answer
State
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Your answer
Zip Code
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Your answer
Phone Number
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Your answer
Are you CPR & First Aid Certified?
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Yes
No
CPR & First Aid Certifications
Please email a copy of your certification(s) to bestoflifeforever@gmail.com
What are the last 4 digits of your Social Security Number?
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Your answer
What is your Drivers License Number?
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Your answer
What state was your Driver's License issued in?
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Your answer
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