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User Information

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Middle Name

Last Name

Gender

Birth Date

Office Phone

Mobile Phone

Home Address

Address

City

Postal Code

Country

State

Work Address

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City

Postal Code

Country

State

Chaplaincy Information

Chaplaincy Area

Chaplaincy Type

Total Years of Ministry

Spouse Name

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Position

Name of Supervisor

Division

Union

Conference

Education (Required - Please add at least one)

CPE

Military Service

Have you served in the Military? Yes No

Service Status

Service Branch

Number of Years Enslisted

Number of Years as Officer

Discharge Type

Highest Rank

Highest Award

Occupational Specialty

Were you Adventist during your military service? Yes No

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The Adventist Chaplain

For God and Country

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