Data Form - ICANA - Isoko Clergy Association Of North America

Membership Data Form

Kindly fill out this data form so we can know you better and serve each other better.

Designation

Name

First

Last

Phone Number

Alternate Phone Number (incase of emergency)

Community of Origin

Local Government Area (L.G.A)

Highest Level of Education

Professional Field

Other Areas of Gifting/Skills You Have

Spouse Profession/Skills Set

Ministry Affiliations

Address in the USA

Name Of Your Ministry

Ministry Address

Full time/Part time?

How long in Ministry?

Type of ministry: church, (Itinerary, Special Need Ministry, etc)

Marital Status

Number of children

If you are human, leave this field blank.