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?*

YesNo
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.*

YesNo
Social Security #*
Required for Background Check
Todays Date*

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

Volunteer Application