Name *

First Name

Last Name

Spouse Name

First Name

Last Name

Primary Phone Contact *

Please enter your primary phone contact information.

(###)

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Home Address *

Please enter your HOME address here.

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Is this new address? *

Has your address changed since your previous renewal?

No

Yes

Membership Level *

Please check ONE box designating your MMFI Membership Level. Select only ONE box per form.

O - Ordained - $140 ($50 Late Processing Fee applies if renewing, with board review, after 2/28/25)

L - License to Minister - $140 ($50 Late Processing Fee applies if renewing, with board review, after 2/28/25)

F - Fellowship Member (no credentials) - $70 ($50 Late Processing Fee applies if renewing, with board review, after 2/28/25)

Ministry Address

Please enter your MINISTRY address here (if it's different from your HOME address).

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Office Phone (if applicable)

(###)

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