Personal Endorsement Form
for the
Covenant of Inclusion

As a Minister of the Christian Church (Disciples of Christ),
I hereby bear witness that I have signed and will display the
Covenant of Inclusion. I  am affirming the listing of my name
among those who have signed this covenant and my desire to 
participate in the Covenant of Inclusion listserve.

______________________________________________________________
Title   First Name   Middle Name       Last Name


______________________________________________________________
Address                     City            State   Zip + Four

__________________   ___________________   ___________________
Primary Phone        Secondary Phone       Fax 

__________________   ___________________   ___________________
Cell Phone           Work Phone            Pager

__________________   ___________________   ___________________
Primary E-Mail       Secondary  E-Mail     Web Site 

__________________   ___________________   ___________________
Congregation         Area                  Region 

Type of ministry: ____________________________________________

Please check as appropriate:  

___ I will consider conveying my actions to my regional/area 
minister(s), and include it in my ministerial profile, and 
offer my services to the Church.

___ I am already a member of GLAD Alliance.

___ I have enclosed my membership in GLAD Alliance.

___ I am interested in learning about the process whereby 
congregations become Open & Affirming.

______________________________________________________________


Print, fill out and send this form to:
COVENANT OF INCLUSION
GLAD Alliance Inc.
P.O. Box 44400
Indianapolis, IN 46244-0400

For more information, contact us at: coi@gladalliance.org

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