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Your Congregation

Your Address

Your City

Your State

Your Zip Code

This form is to certify that the Congregation listed below will complete the following

1. We agree to adopt or implement one or more Military Ministry Programs

2. We agree to advertise the existence of the Military Ministry Program(s) in one or more of our congregation publications (service bulletins, newsletters, etc.) so that their existence is easily visible to visitors, members, and leadership of the congregation

We provide permission to the Military Chaplains Association and their affiliates to list our congregation information on their web site

Optional. We would also like to be a Lead Congregation and help establish Veteran/Military Ministries in parishes and congregations in our vicinity
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Denomination

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Clergy first and last name

Clergy Title

Clergy email

Clergy phone number

Lay Leader Contact Info:

Lay Leader first and last name

Lay Leader email

Lay Leader phone number

I consent to conditions 1, 2, and 3 above.

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