Please Type or Print  (Current members, please circle new info)

Membership Year:

2008

Date:

Full Name: (Ms.)   (Mrs.)   (Mr.)
            

Spouse’s Name:
        

             Last

First

Middle

Employer:  

Annual Conference:
 

Job Title:  

Years Employed: 

Business Address:
 

City/State/Zip+4:
 

Business Phone:
 

Business Fax:
 

Business E-mail: (PLEASE PRINT CLEARLY)
 

Previous UMC Employment:

Years Employed:

Home Address:
 

City/State/Zip+4:
 

Home Phone:
(please indicate if private number)   

Home E-mail:
 

Preferred Mailing Address:     Business o           Home o

Birth Date (MM/DD):

Add email to Prayer Net:  Yes o   No o  Already on o

E-mail:

Add email to Linking Hands: Yes o  No o  Already on o

E-mail:

National PAUMCS Membership (Year Joined):

Have you attended an annual conference?

Year:

Name of Local Chapter:

Year Joined Chapter:

Officer/Committee Member Local: Yes o   No o

Position currently held:

GCFA Certification:  Yes o   No o

Year:

Renewed Certification: Yes o   No o   Latest Year:

GCFA Advanced Certification:  Yes o   No o

Year:

If called to serve as an officer or on a committee for national PAUMCS, would you be interested?  Yes o   No o   Maybe o

Which office(s) or area(s)?

Please indicate past service

(Optional: list your special gifts, leadership experience, and your dreams for PAUMCS on separate sheet and attach)

Educational Background:

Check ethnic background for statistical data only:      African American/Black o            Asian American o
Hispanic American o            Native American o            Pacific Islander o            White o           Multi-Racial o
Other:___________________________ 

Please check if you are physically challenged o