Name *

First Name

Last Name

Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Phone (cell)

(###)

###

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Phone (work)

(###)

###

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III. How may the Presbytery be of service to you?

I would like to be considered for service on a Presbytery committee, work group or task force.

I would like closer contact with other retired ministers.

I would like pastoral contact from the Committee on Ministry.

Other (please explain below).