Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Phone *

(###)

###

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Head Pastor Name *

First Name

Last Name

Main Point of Contact Name *

Who will be the main person operating Care Portal at your church?

First Name

Last Name

We affirm the Project Belong Network’s Statement of Faith. *

Yes

No

We affirm the Project Belong Network’s Guiding Principles. *

Yes

No

We affirm the Project Belong Network’s Core Commitments. *

Yes

No