First Name:  * Last Name:  * Address:  * City:  * State:  * Zip Code:  * Phone Number:  * Email Address: District  * Local Church Membership  * Indicate: OrdainedLicensedLaypersonCommissioned Evangelist TenuredCommissioned EvangelistRegistered EvangelistEvangelism Service RetiredCommissioned Song EvangelistRegistered Song Evangelist It is my intention TO SPEND THE MAJOR PART OF MY TIME in evangelism during the coming year YesNo I request the District Assembly to grant me the following Evangelist's Commission TenuredEvangelist's CommissionEvangelist's RegistrationEvangelism Service RetiredSong Evangelist's CommissionSong Evangelist's Registration Number of continuing education credits earned this year  * Enrolled in graduate program? YesNo Number of revivals held  * In which districts?  * In what ways have you supported the Church of the Nazarene?  * Personal Testimony  * Please initial below to verify all information is correct. Initials  * Once you submit the form you will be taken back to the District Secretary Home Page Do not enter anything in this field:

* indicates a required field