Clergy Report

International Christian Community Churches, Inc. Annual Clergy Reporting Form Please send this form along with a check or money order made payable to ICCC in the amount of $50 (US) no later than December 31 to Rev. Emily Bel, BoM Chair, PO Box 8042, Columbus GA 31908. Name: Address: Home Phone Cell Work E-mail: Church: Position: Year credentialed/ordained in ICCC: or Installed as Lay Pastor: If your primary ministry is NOT in the above church, please indicate type and location of ministry here:

Date

Documentation of Continuing Education Event/Training Sponsor

Contact Hours

If approved by BoM for independent study, please indicate here and attach documentation as requested by the BoM. I hereby certify that I have not been charged with nor convicted of any criminal offense during this reporting period. I hereby certify that the information provided in this report is true and accurate.

______________________________________________ Signature

_____________________ Date

_________________________________ ICCC Pastors’ Manual 04.2007 Page 1