Name of Congregation or Faith Community?*

Address*

Church Email*

Church Phone*

Church Organized Date*

Doctrinal Statement *

Pastor's Name*

Pastor's Birthday*

Pastor's Phone*

Pastor's Email*

Pastor's Home Address*

Pastor's wife's name*

Wife's Birthday*

Wedding Anniversary *

Please list any staff. Include names and positions*

Please write a brief paragraph on why you desire to partner with Piedmont Baptist Association? How will this partnership impact our community?*

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