GLPA Application

Personal Details

Name *

First

Last

Birthdate *

Email *

Email

Confirm Email

Primary Phone *

Alternate Phone

Address *

Address Line 1

Address Line 2

City

State / Province / Region

Postal Code

Country

Are you married? *

Yes
No

Spouse Name

First

Last

Spouse Email

Email

Confirm Email

Spouse Birthdate

Wedding Anniversary

Church Information

Church Name *

Church Address *

Address Line 1

Address Line 2

City

State / Province / Region

Postal Code

Country

Church Email *

Email

Confirm Email

Church Phone *

Church Website *

Alternate Church Phone

Church Fax

Church Anniversary *//

Membership Size *

Number of Staff *

Approximate number of staff/leadership

Contact Name *

First

Last

Contact Email *

Email

Confirm Email

Church Office Hours *

Additional Information

What are your expectations for this alliance? *

Church Vision and Mission Statement *

How did you hear about GLPA *

Personal Details

Church Information

Additional Information

Note: GLPA has an Annual Subscription fee of $500.00