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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
Your answer
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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