City State Zip
Your age Birthday
Has there been a change in your marital status during 2015?
If yes, please explain:
(Please mark an x in the correct box.)
My current ministry is: Evangelist Pastor
Assistant Pastor Teacher Jail/Prison Ministry Street Ministry
Nursing Home Ministry One-on-One Counseling Music
Other (please explain)
I am in ministry: Full-time Part-time Retired from active ministry
Not active at present time, but please renew my affiliation, so I am ready to go as the Lord directs.
Has anything changed in your personal life that could in any way adversely affect your ministry status or activity?
If you answered yes, please explain:
Please select credentials you currently have:
Commissioned Minister $50 Minister of Music $50
Exhorter’s License $50 Minister’s License $75 Ordination $100
PLEASE PLACE THE FOLLOWING ON MY CREDIT CARD:
1) $ to cover my 2016 affiliation costs.
2) Please also place $ as an extra gift to help in the ministry of EMA.
TOTAL AMOUNT TO BE PLACED ON MY CREDIT CARD:
3) I am NOT renewing. Please remove my name from your files.
To the best of my knowledge, I am living my life by the Holy Scriptures. I know of no scriptural reason to bar me from continuing in my ministry.
I submit that all of the above is true. Please type your name here to sign
Please feel free to list any needs your family or ministry might have that you would like our staff to agree with you in prayer concerning:
Do you have any suggestions for Brother Ford concerning the ministry of E.M.A.?
YOUR FINAL TWO STEPS:
1) CLICK ON THE SUBMIT BUTTON TO EMAIL YOUR APPLICATION.
2) INPUT THE AMOUNT YOU DESIRE EMA TO CHARGE ON YOUR CARD (ABOVE)... THEN CLICK THE DONATE BUTTON.
YOU WILL THEN BE DIRECTED TO A WEBPAGE WHERE YOU CAN FILL IN PERTINENT INFORMATION IN REGARDS TO THE CREDIT CARD YOU ARE USING. (NO PAYPAL)
THANKS FOR STANDING WITH E.M.A. TO HELP US STRENGTHEN "INDEPENDENT" MINISTERS WORLDWIDE AS WELL AS OUR MISSION OUTREACHES.
EMA RENEWAL APPLICATION FOR 2017
(This renewal form is for CREDIT CARDS ONLY.)
Please fill in all the information below. Then follow the last two steps at the
bottom. Please renew by December 10th.