Membership Application

[et_pb_section fb_built=”1″ admin_label=”section” _builder_version=”4.16″ global_colors_info=”{}”][et_pb_row admin_label=”row” _builder_version=”4.16″ background_size=”initial” background_position=”top_left” background_repeat=”repeat” global_colors_info=”{}”][et_pb_column type=”4_4″ _builder_version=”4.16″ custom_padding=”|||” global_colors_info=”{}” custom_padding__hover=”|||”][et_pb_text admin_label=”Text” _builder_version=”4.16″ background_size=”initial” background_position=”top_left” background_repeat=”repeat” global_colors_info=”{}”]You can also download the Membership Application here.This forms is available in Adobe Acrobat format (PDF). To view this file, you must have the FREE Adobe Acrobat Reader installed on your computer.[/et_pb_text][et_pb_contact_form _builder_version=”4.21.0″ _module_preset=”default” _unique_id=”40b8b03e-2290-4b36-8150-227f9dc96ad3″ email=”membership@cocipm.org” hover_enabled=”0″ sticky_enabled=”0″ captcha=”off”][et_pb_contact_field field_id=”Name” field_title=”Name of Church/Organization” _builder_version=”4.21.0″ hover_enabled=”0″ global_colors_info=”{}” button_text_size__hover_enabled=”off” button_one_text_size__hover_enabled=”off” button_two_text_size__hover_enabled=”off” button_text_color__hover_enabled=”off” button_one_text_color__hover_enabled=”off” button_two_text_color__hover_enabled=”off” button_border_width__hover_enabled=”off” button_one_border_width__hover_enabled=”off” button_two_border_width__hover_enabled=”off” button_border_color__hover_enabled=”off” button_one_border_color__hover_enabled=”off” button_two_border_color__hover_enabled=”off” button_border_radius__hover_enabled=”off” button_one_border_radius__hover_enabled=”off” button_two_border_radius__hover_enabled=”off” button_letter_spacing__hover_enabled=”off” button_one_letter_spacing__hover_enabled=”off” button_two_letter_spacing__hover_enabled=”off” button_bg_color__hover_enabled=”off” button_one_bg_color__hover_enabled=”off” button_two_bg_color__hover_enabled=”off” sticky_enabled=”0″][/et_pb_contact_field][et_pb_contact_field _builder_version=”4.21.0″ _module_preset=”default” field_id=”Address” field_title=”Mailing Address” hover_enabled=”0″ sticky_enabled=”0″][/et_pb_contact_field][et_pb_contact_field field_id=”Email” field_title=”Email Address” field_type=”email” _builder_version=”4.16″ global_colors_info=”{}” button_text_size__hover_enabled=”off” button_one_text_size__hover_enabled=”off” button_two_text_size__hover_enabled=”off” button_text_color__hover_enabled=”off” button_one_text_color__hover_enabled=”off” button_two_text_color__hover_enabled=”off” button_border_width__hover_enabled=”off” button_one_border_width__hover_enabled=”off” button_two_border_width__hover_enabled=”off” button_border_color__hover_enabled=”off” button_one_border_color__hover_enabled=”off” button_two_border_color__hover_enabled=”off” button_border_radius__hover_enabled=”off” button_one_border_radius__hover_enabled=”off” button_two_border_radius__hover_enabled=”off” button_letter_spacing__hover_enabled=”off” button_one_letter_spacing__hover_enabled=”off” button_two_letter_spacing__hover_enabled=”off” button_bg_color__hover_enabled=”off” button_one_bg_color__hover_enabled=”off” button_two_bg_color__hover_enabled=”off”][/et_pb_contact_field][et_pb_contact_field _builder_version=”4.21.0″ _module_preset=”default” hover_enabled=”0″ sticky_enabled=”0″ field_id=”phone” field_title=”Telephone Number”][/et_pb_contact_field][et_pb_contact_field fullwidth_field=”on” _builder_version=”4.21.0″ _module_preset=”default” field_type=”checkbox” checkbox_options=”%91{%22value%22:%22I Agree%22,%22checked%22:0,%22dragID%22:-1}%93″ field_id=”Agree” field_title=”This church/organization must be founded upon the belief in the Virgin birth, crucifixion, burial and resurrection of the Lord Jesus Christ. There is no other name given under the heavens whereby men can be saved. Indicate by checking box.” hover_enabled=”0″ sticky_enabled=”0″][/et_pb_contact_field][et_pb_contact_field fullwidth_field=”on” _builder_version=”4.21.0″ _module_preset=”default” field_id=”Prison_Involvement” field_title=”Describe current prison/jail involvement:” field_type=”text” hover_enabled=”0″ sticky_enabled=”0″][/et_pb_contact_field][et_pb_contact_field fullwidth_field=”on” _builder_version=”4.21.0″ _module_preset=”default” field_title=”Will the applicant church be able to participate in the ministry as listed below. Check box if agree.” field_id=”Participation” field_type=”checkbox” checkbox_options=”%91{%22value%22:%22Seek State certification as soon as possible%22,%22checked%22:0,%22dragID%22:-1},{%22value%22:%22Participate in worship Services at adopted Prisons at least once per year%22,%22checked%22:0,%22dragID%22:0},{%22value%22:%22Pay annual membership dues%22,%22checked%22:0,%22dragID%22:1},{%22value%22:%22Attend bi-monthly meetings of the Coalition six times/year%22,%22checked%22:0,%22dragID%22:2},{%22value%22:%22Lead Trusty Camp services on Sunday mornings%22,%22checked%22:0,%22dragID%22:3},{%22value%22:%22Lead Saturday School classes 4 times a year%22,%22checked%22:0,%22dragID%22:4},{%22value%22:%22Participate in the Christmas Gift-of Light ministry including annual donation, decoration of sacks, stuffing and delivering sacks to adopted units.%22,%22checked%22:0,%22dragID%22:5}%93″ hover_enabled=”0″ sticky_enabled=”0″][/et_pb_contact_field][et_pb_contact_field fullwidth_field=”on” _builder_version=”4.21.0″ _module_preset=”default” field_id=”Delegates” field_title=”List the name of your church/organization’s designated representatives (2) to the Coalition and their contact information:” field_type=”text” hover_enabled=”0″ sticky_enabled=”0″][/et_pb_contact_field][/et_pb_contact_form][/et_pb_column][/et_pb_row][/et_pb_section]