Registration Form

Has your group been registered or incorporated on Church of the East's listing before?

Please provide the following information:

First Name	*
Last Name	*
Middle Initial
Title	If other, please explain in Optional below
The group's name that you are applying for. Names are registered on a first-come basis.	1st choice* 2nd choice*
Street Address	*
Address (cont.)
City	*
State/Province Please write in full, don't abbreviate	*
Zip/Postal Code	*
Country
Phone	We will contact you to confirm details before mailing
Phone2 / FAX
E-mail Email again	* (please repeat email address)
Mailing Address Exact as used for postal label	Your membership certificate, card and other items will be mailed to this address *
Contact person and details for public use:	This information will be PUBLIC
Community officers. List the names and titles of your community's officers.	*
Number of members in 2002
Public Contact Email Address	This information will be PUBLIC
Year of founding. When was your community founded	This information will be PUBLIC
Type of Organization you register
URL

Please provide the following personal information:

Birthday	yy/mm/dd *
Gender	Male Female *

Please tell us a little about your group

Brief description for registry listing. Must include the geographic area and specific interest-group (if any) you serve. Maximum 200 characters. This information will be PUBLIC

Full description. This information will be PUBLIC

Are you available for election to the executive in your area? Yes Not at the moment

Members of the executive receive additional material and goods. If you select Yes above, we will contact you to verify your mailing address. Please check again if we have the correct contact details.

Optional: You may add any Comments or Questions. If you need to motivate your chosen name, please do it here. If you would like to offer any services or assistance, skills or advice, please add it here.

New International Community Register