Cell Group Leader’s License Application

Cell Group Leader's License

Contact Information

Name(Required)

First Middle Last Suffix

Mailing Address(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Physical Address(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Phone(Required)

Email(Required)

Previous Address (A)(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

How long?(Required)

Previous Address (B)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

How long?

Previous Address (C)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

How long?

How did you learn about ICCM?(Required)

How?(Required)

ICCM Director's name?(Required)

Are you a faithful and consistent tither to your Church?(Required)

If no, provide a detailed explanation below as to why, as a non-tither, you should be considered for this high position.(Required)

Personal Information

Are you a U.S. Citizen?(Required)

Social Security Number(Required)

Gender(Required)

Driver's License Number(Required)

State(Required)

Marital Status(Required)

Name of Spouse(Required)

Number of Children(Required)

When?(Required)

Conditions under which divorce was granted:(Required)

Reason(Required)

Church Information

What Church do you attend?(Required)

Address(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

How long have you been a member?(Required)

Is your Pastor aware you are filing for Cell Group Leader License?(Required)

If no, what are your reasons for applying for this license?(Required)

Will you agree to sign our Non-Compete and Non-Disparaging Agreement to protect your Pastor and your Church?(Required)

Application Acceptance Agreement

I hereby declare that each of my statements given or made in this application and any supporting documents are correct and true; I solemnly pledge to abide by all promises and statements contained therein.

Application Signature(Required)

Date Signed(Required)

Pastor's Endorsement

I hereby consent for the above Member of my Church to receive their Cell Group Leader's License. I understand they will be required to sign a Non-Compete and Non-Disparaging Agreement to protect my Church and me from splits and divisions.

Senior Pastor's Signature(Required)

Cell Number(Required)

Date Signed(Required)

Payment Information

License Application Fee

Total

Credit Card

American Express

Discover

MasterCard

Visa

Card Number

Expiration Date

Security Code Cardholder Name

I agree to receiving marketing and promotional materials.

Name

This field is for validation purposes and should be left unchanged.