Name *

First Name

Last Name

Date of Birth *

MM

DD

YYYY

Address *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Gender *

Male

Female

Marital Status *

Single

Married

Divorced

Widowed

Phone Number *

(###)

###

####

Are you currently a Vintage Partner? *

Yes

No

Have you ever served in the local church? *

Yes

No

Reference 1: *

First Name

Last Name

Phone *

(###)

###

####

Reference 2: *

First Name

Last Name

Phone *

(###)

###

####

Phone *

(###)

###

####

Phone *

(###)

###

####

Do you agree with Vintage Church's theological beliefs? *

Vintage's theological beliefs can be found here.

Yes

No

Do you affirm the mission and values of Vintage Church and agree to cooperate and serve alongside the pastors of the church? *

Vintage's mission and values can be found here.

Yes

No

Date *

MM

DD

YYYY