Young People's Ministry Council Application
Please use this form to apply for membership in Susquehanna Conference Young People's Ministry Council.
Sign in to Google to save your progress. Learn more
General Information
Name *
Please enter your full First and Last Names.
Age Group *
Please Select Your Age Group.
High School Graduation Year *
Please Select Your High School Graduation Year.
Please Enter Your Age.
Birth Date *
Please Enter Your Birth Date.
Gender *
Please Select Your Gender.
Home Phone
Please Enter Your Home Phone Number.
Cell Phone
Please Enter Your Cell Phone Number.
Willing to Receive Text Messages? *
Are You Willing to Receive Text Messages?
Address *
Please Enter Your Home Street Address and P.O. Box (if applicable).
City *
Please Enter Your City.
State *
Please Enter Your State.
Please Enter Your ZIP Code.
Email *
Please Enter Your Email Address.
Local Church Name and City *
Please Enter the Name of Your Local Church and the City.
District *
Please Select Your District.
Local Church Pastor's Name *
Please Enter Your Local Church Pastor's Full Name.
Pastor's Phone Number *
Please Enter Your Local Church Pastor's Phone Number.
Clear form
Never submit passwords through Google Forms.
This form was created inside of Susquehanna Conference. Report Abuse