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THE CHURCH OF GOD IN CHRIST
COGIC 2017 AUXILIARY IN MINISTRY CONVENTION YOUTH USHERS RECRUITMENT FORM
First Name *
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Last Name *
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Age *
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Phone Number *
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Email Address *
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Name of Jurisdiction *
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Jurisdictional Bishop *
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Jurisdictional Supervisor *
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Name of Local Church *
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Pastor *
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Local Church Usher Board President *
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Phone Number *
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Email Address
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Number of Years Served as Youth Usher *
Your answer
AIM Arrival Date *
MM
/
DD
/
YYYY
AIM Departure Date *
MM
/
DD
/
YYYY
Name of Parent, Guardian, and/or Chaperon at AIM *
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Contact Phone Number at AIM *
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Name of Hotel *
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Please state any known medical problems that you would like for us to be aware of: *
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Emergency Contact Name *
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Emergency Contact Number *
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Relationship *
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