AR - JGLM Annual Renewal Application

JGLM Annual Renewal Application
John G. Lake Ministries
P.O. Box 742947
Dallas, TX 75374
Phone:888-293-6591
Email: iac@jglm.org
Website: http://www.jglm.org

JGLM requires all JGLM Leadership to update their information each year if they plan to continue on with JGLM. This includes all:

1.Licensing Renewal
2. Provisional Licensing
3. Regional Directors
4. State Directors
5. Healing Room Overseer
6. Life Team Leader
7. Certified DHT

Please fill out all information that applies to you to update your:

A. Registration
B. Contact Information

There is an additional comment box if needed at the end of this application for your convenience. Thank you for your help!

Please Submit Individually for Spouse and Yourself.

Name First Last
Middle Initial
Address
Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country
Home Phone - ### - ### ####
Mobile Phone - ### - ### ####
International Phone Number
International Mobile Number
Email
Skype Username
Passport Photo Upload
Are you a monthly pledge partner
Yes No
Did you financially support JGLM this past year?
Yes No
Are you currently volunteering with JGLM?
Yes No
If yes, please tell us what you do as a volunteer.
Please renew the following positions I have indicated
Renewal for:
Licensing with JGLM Provisonal Licensing with JGLM Regional Director State Director Healing Room Overseer Life Team Leader Certified Divine Healing Technican
CDHT Date on Certificate (Issued Date) / MM / DD YYYY
In the last year have you attended a DHT or New Man Teaching?
Yes No
Name of Training and location
Date of Training / MM / DD YYYY
How many JGLM meetings have you attended in the past year?
Are you attending a JGLM Life Team (if not the Leader)
Yes No
Name of Life Team (Host Name)
Are you licensed or ordained? (Other than with JGLM)
Yes No N/A
If so, by whom?
Are you requesting consideration for licensing or ordination by JGLM?
Yes No N/A
Healing Room Information
Are you affiliated with any Healing Rooms other than with JGLM?
Yes No N/A
If so, which one/s?
Briefly, what are your goals for the coming year?
Briefly explain why you wish to remain in union with JGLM.
Any Additional Comments:
Please Read The Following Carefully Before Signing!

I acknowledge that I agree with the Ministerial Ethics set forth by JGLM.
I hereby state my willingness to submit to the spiritual authority and guidelines of JGLM.
At any time I feel I can no longer agree with the beliefs and practices of this organization or if it is requested by those in authority, for any reason, I will forfeit and return my Ministerial Certificate to JGLM.
I understand that It is a requirement for all JGLM affiliates to stay in contact either by monthly or quarterly reports or by contacting the International Headquarters.
By signing this renewal application I agree with the conditions set forth in the paragraph above and I hereby state that all information contained on the renewal is correct and true.
I also acknowledge that I will receive a copy of this form at the email specified in my application above.
Electronic Signature
Date of Application / MM / DD YYYY

AR - JGLM Annual Renewal Application

AR - JGLM Annual Renewal Application

Please renew the following positions I have indicated

Healing Room Information

Please Read The Following Carefully Before Signing!