Church Status Reporting *

Select one option.

Existing Church joining the UPCI (Complete Section 1)

Newly Formed Church (Complete Section 1)

New Daughter Work (Complete Sections 1 & 2)

Daughter Work becoming Autonomous (Complete Sections 1 & 2)

Date Estapblished

MM

DD

YYYY

Physical Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Mailing Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Mother Church Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Mother Church Pastor's Name

First Name

Last Name

Listing Options for Directory

Select one option

List the name of the Pastor of the Mother Church only.

List the name of the Pastor of the Daughter Work only (must be licensed with the UPCI).

List both the name of the pastor of the Mother Church and the Daughter Work.