GMCI MAILING ADDRESS
P O BOX 2557
Glendale, AZ 85311
602-277-1953
gmci4u@AOL.com

SOUTHWEST FELLOWSHIP
April 7 & 8, 2023 - Phoenix, AZ

Attention Please

Please do not submit membership dues
without a Renewal application
A Renewal form will be mailed to you.
You can also renew on line.

________________

RENEWAL DONATIONS FOR MEMBERSHIP
$75 iNDIVIDUAL - COUPLE $115

Ames International School of Ministry
vrizzo@amesbible.org

Outreach Ministry

This form not in use*
Ministry Name:*
Legal Address:*
City:*
State:*
Zip code:*
Cell Phone:*
Home Phone:*

Directors Name:*
Email ID*
Does the Director have personal membership with GMCI?
Date Ministry was founded*
Is the Ministry Incorporated? Yes or No*

How did you learn about GMCI?*

From what source does the Ministry get it's income?*
Employer Identification Number (EIN)*
Do you have a copy of the IRS form SS4 that would have been sent to you by the IRS when assigned an EIN*

If you do not have an EIN have you applied for one? (Note it is an IRS requirement that you have an EIN)*
Does the Ministry have a checking account?*
Is all Ministry income deposited in checking account?*


Is counseling a part of this Ministry?*
Do you have liability insurance?*
Does your insurance cover counseling?*


Give a summary of the nature of this Ministry*
Have you ever been denied tax exemption status with the IRS?*
If yes give reason
Does anyone receive financial compensation from this ministry?*
Has this Ministry been filing any kind of tax returns?*
If yes what forms have been filed?
Does this Ministry or the Director have any kind of civil or criminal charges or lawsuits pending? If YES give summary*
Do you agree with our Statement of Faith?*

Do you agree with our Code of Ethics?*

Do you understand that membership with GMCI is renewed annually?*
OFFICERS - Directors Name:*
Secretary:*
Treasurer:*
Other Board member



Agreement: To the Membership Committee as the President/Director/Board Member of this ministry I hereby agree that this ministry will abide by all the guidelines of GMCI and the IRS as it relates to income. By affixing my name to this from I attest that all information is true and factual. Insert Name*


NOTE: TO PAY DUES BY CREDIT OR DEBIT CARD CLICK ON THE RED X AT THE UPPER RIGHT-HAND SIDE OF THIS FORM
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GMCI OFFICE USE ONLY:

Date Rec'd:_______/______/_______ Dues Rec'd: $____________ How paid:_____________

Membership Committee Results:____________________________________

If approved, data entered: _____/_____/______ Date mailed: _____/_____/______