Signature Form

Contact Information

Please complete the following form to be listed as either a pastor or supporter as well as to receive updates about the declaration and related activities. (NOTE: Pastors' titles and church names are for identification purposes only and do not necessarily constitute a position of that church. Endorsement of this declaration does not require or necessarily indicate affiliation with this or any organization.)

IF YOU ARE ALREADY LISTED ON THE "SUPPORTING PASTORS" PAGE IT IS NOT NECESSARY TO COMPLETE THIS FORM

*Please Note: Your name will not be listed immediately after submission, as the list is updated manually. Please allow 2 days for your name to be added.

	I am a pastor and I support this declaration!
	I am not a pastor and wish to support this declaration!
	Please send information on forming a local pastor council
First Name: *
Last Name: *
Staff position (use up or down arrow to scroll): *
Church Name: *
Address Street 1: *
Address Street 2:
City: *
Zip Code: *	(5 digits)
State: *
Daytime Phone: *
Email: *
Comments:	Enter comments here!