Request for Lay Ministry Certificates Form

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	Request for Lay Ministry Certificates

Please provide contact information (* Required field)

* District Name:

* Send Certificates To:

* Signed By (SMSB Secretary):

Send Certificates to the local pastor?

* Name (to appear on certificate):

* Church Name (i.e. First, Central)

* Location (of presentation)

* Date (DD/MM/YY)

* Mailing Address:

* E-mail Address: