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APPLICATION FOR MEMBERSHIP
NAME :
__________________________________________________________________
ADDRESS : __________________________________________________________________
__________________________________________________________________
PHONE : HOME: ____________________________PAGER: _____________________
WORK
: ____________________________CELL: ______________________
FAX:
________________________________________________________
E-MAIL
: _________________________________________________________
FAITH / DENOMINATION : _______________________________________________________
DEPARTMENT SERVED: NAME: __________________________________________________
ADDRESS :__________________________________________________________________
CHIEF / DETACHMENT COMMANDER: ____________________________________________
DATE APPOINTED CHAPLAIN: ___________________________________________________
DEPARTMENT SIZE: SWORN:_________________
CIVILIAN: ___________________
TYPE OF CHAPLAINCY: FULL
TIME _____________________________________
PART
TIME _____________________________________
VOLUNTEER
_____________________________________
STATUS OF CHAPLAIN: ORDAINED
: _____________ DATE : __________________
LICENSED:
_____________ DATE : __________________
OTHER
: _____________
EXPLAIN : _______________
YEARS IN PASTORAL MINISTRY : ________________________________________________
EDUCATION : COLLEGE
: ________________ DEGREE :______________
SEMINARY
: _______________ DEGREE : _____________
UNIVERSITY
: ______________ DEGREE : _____________
SPOUSE'S NAME (IF APPLICABLE): ______________________________________________
SIGNATURE: __________________________________
DATE: ________________________
PLEASE INCLUDE THE FOLLOWING WITH YOUR APPLICATION
Letter of appointment by department
Letter of endorsement by ecclesiastical superior
initial dues ($50.00)
Mail application to :
Chaplain Charlie Massey
1732 10th St. E., Courtenay, BC, V9N 7H7
Phone : (250) 338-2267 Fax : (250) 897-0099
E-mail : membership@cndpolicechaplains.org
Pager : (250) 897-7993
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