Sponsoring Pastor's Name *

First Name

Last Name

Phone *

(###)

###

####

Address of Sponsoring Church *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Leadership

If approved, do you have a minister who will be overseeing this preaching point?

Yes

No, I will be overseeing the work.

Have you contacted them?

Yes

No

Date Established

You can just enter a starting date in the past or the future for when you want to start.

MM

DD

YYYY

Physical Address of Preaching Point

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Mailing Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Funding *

I understand no financial funds will be available from the Georgia District UPCI or the UPCI as long as the church remains in preaching point status.

I understand and agree

Applicant Name

First Name

Last Name

Date of Application

Enter today's date.

MM

DD

YYYY