Organizational Membership Application – One Year

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Organizational Membership / $50.00 USD / One Time (for 1 year access)

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First Name *

Last Name *

Email Address *

Username (lowercase alphanumeric) *

Password (type this twice please) *

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Additional Info

Contact Details (only visible to you and site admins)

Name Prefix

Street Address *

City *

State or Province *

Postal Code *

Country *

Secondary Email

Telephone

Organization/Institution Details (only visible to you and site admins)

Enter the name(s) of any organizations with which you are affiliated. (Optional, but required for Organizational Partnerships.)

Referral Information

Name of church leader or current GEN member who can provide a reference for you *

Email address of above individual *

Telephone number of above individual *

Please check this box to indicate your affirmation and agreement with the GEN Vision and at least one of the following statements of faith: the Nicene Creed, the World Evangelical Alliance or the the Lausanne Covenant.

How did you hear about GEN? (E.g., friend, conference, website, etc.)

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Card Number (no dashes or spaces) *

Card Expiration Date (mm/yyyy) *

Card Verification Code * need help?

Card Start Date (mm/yyyy), or Issue Number *

Billing Address

Street Address *

City / Town *

State / Province *

Postal / Zip Code *

Country *

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