CHAIN MEMBERSHIP APPLICATION

ALL questions must be answered or lack of an answer must be explained in the comment section (put NA if not applicable). All information is confidential unless your permission is given to the contrary. All personally identifying information is held strictly confidential (i.e. last name, street address, phone numbers). No information is given to mailing lists or other commercial vendors. Once your picture is received (Required for US residents) you will receive a password to access "Member Only" pages. Please be patient as it takes time to get this done. I hope to see you on IRC soon! God bless!


IRC NICKNAME*:
PASSWORD* (6-8 Characters - letters only, CaSe SeNsitIVe):
ISP E-MAIL* (Address given by your Internet Service Provider):
E-MAIL* (Address you want CHAIN to use):
URL (Your home page):
FIRST & LAST NAME*:
STREET ADDRESS* (Line One):
STREET ADDRESS (Line Two):
CITY, STATE, ZIP*: ,
COUNTRY*:
HOME PHONE*:
WORK PHONE*:
BIRTHDATE*: MONTH DAY YEAR (I.E. 1963)
MARITAL STATUS*:
SPOUSES NAME:
OCCUPATION*:
CHURCH AFFILIATION* (Church or Denomination):
TESTIMONY* (How did you come to know Jesus?):
ADDITIONAL COMMENTS:
WOULD YOU LIKE YOUR PHOTO IN THE CHAIN SCRAPBOOK: yes no
If yes, please email a .jpg or .gif to pictures@chain.org
or mail your photo with a self-addressed stamped return envelope to:

CHAIN
Attn: Membership
P.O. Box 1102
Kennesaw, GA 30156