Volunteer Application Form

Volunteer Application
Name

First NameLast Name
E-mail
Phone Number

Area CodePhone Number
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Date of Birth

MonthDayYear
How long have you been attending Pittsfield Assembly?
Area of Interest
Do you feel comfortable sharing your faith and leading someone to Christ?
Comments
Applicant's Statement
I understand that a criminal and sex offender background check is mandatory. Therefore, I give my consent to the release of any pertinet federal, state, county, or municpal conviction information.
Social Security #
Required for Background Check
Todays Date

MonthDayYear
Enter the message as it's shown
Should be Empty:

Volunteer Application