CHAPLAIN INFORMATION FORM
(Chaplaincy Ministry – Louisiana Baptist Convention)
 
This form is for the informational and contact purposes of the Louisiana Baptist Convention Chaplaincy Ministry.  Therefore, all Louisiana Baptist Chaplains are encouraged to participate.  The information gathered will not be shared with those outside of the Louisiana Baptist Convention with out permission being granted by answering "Yes" to the information permission questions at the end of this form.
 
Thank you for your service.
 
First Name  
Last Name  
Given Name  
Mailing Address  
City  
State  
Zip  
Alternate Address  
City  
State  
Zip  
Contact Numbers  
Office  
Home  
Fax  
Cell  
Email Address  
What is the name of the organization where you are a chaplain?  
What are your responsibilities?  
How many years have you been a chaplain?

Are you endorsed by the North American Mission Board  
If "yes", what is the date of your endorsement?
If 'no", would you be interested in NAMB Endorsement?  
Do you give the LBC Chaplaincy Ministry Coordinator permission to share your contact information with another chaplain?
Do you give the LBC Chaplaincy Ministry Coordinator permission to share your contact information with those from the general public seeking to contact you as a chaplain?