Membership Application Home » Membership Application Salesforce Web-to-Lead Form First Name Last Name Ministry Email Phone Birthdate (Use format MM/DD/YYYY): Street City State (only complete this field if you are in the United States, otherwise leave blank) AL AK AR AZ CA CO CT DE DC FL GA GU HI ID IL IN IA KS KY LA ME MN MD MA MI MN MS MO MT NE NV NH NJ NM NY NC ND MP OH OK OR PA PR RI SC SD TN TX TT UT VA VT VI WA WV WI WY Country AF AX AL DZ AD AO AI AQ AG AR AM AW AU AT AZ BS BH BD BB BY BE BZ BJ BM BT BO BQ BA BW BV BR IO BN BG BF BI KH CM CA CV KY CF TD CL CN CX CC CO KM CG CD CK CR CI HR CU CW CY CZ DK DJ DM DO EC EG SV GQ ER EE ET FK FO FJ FI FR GF PF TF GA GM GE DE GH GI GR GL GD GP GT GG GN GW GY HT HM VA HN HU IS IN ID IR IQ IE IM IL IT JM JP JE JO KZ KE KI KP KR KW KG LA LV LB LS LR LY LI LT LU MO MK MG MW MY MV ML MT MQ MR MU YT MX MD MC MN ME MS MA MZ MM NA NR NP NL NC NZ NI NE NG NU NF NO OM PK PS PA PG PY PE PH PN PL PT QA RE RO RU RW BL SH KN LC MF PM VC WS SM ST SA SN RS SC SL SG SX SK SI SB SO ZA GS SS ES LK SD SR SJ SZ SE CH SY TW TJ TZ TH TL TG TK TO TT TN TR TM TC TV UG UA AE GB US UY UZ VU VE VN VG WF EH YE ZM ZW Website Facebook: Instagram: Twitter: Preferred Communication Method: Email Phone Text Physical Mail WhatsApp What Languages do you speak?: Highest education completed: High School Professional Degree Associate's Degree Bachelor's Degree Master's Degree Doctorate School Name: Year Graduated: Will you pursue additional education: Please note, you must provide the names and unique, valid email addresses for two individuals we may contact on your behalf. Failure to do so will result in our inability to process your application until we have received that information from you. Pastoral Reference: Reference Email: Reference Phone: Additional Reference: Additional Reference Email: Additional Reference Phone: Biography – Tell us about yourself: What do you hope to gain/offer with GNE?: How did you hear about GNE?: List any GNE members you know: Agreements can be viewed here: https://www.evangelist.global/join-gne/ I have read and agree to comply with the GNE membership agreement: I have read and agree with the Lausanne Covenant: I consent and understand by providing my personal information, it will be added to the Global Network of Evangelists database and website, upon approval of my application to become a member: Your privacy is important to us. We do not sell, nor will we give away our membership list. We strive to be responsible in our management, truthful in our advertising, and cost-effective in our fundraising. Our registrations are processed through a third-party supplier and all data, including personal and financial information, is secured by their systems. If you have any questions about the security of your personal information or how it is used, please do not hesitate to contact us I agree to the privacy policy: If I choose to be removed from the website, I understand I can do this by emailing my request to gne@palau.org:
