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Affiliation Application

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If you and/or your church would like to apply to become a network affiliate, please fill out the form below.

PLEASE CLICK THE SUBMIT BUTTON WHEN FINISHED.



  1. PLEASE PRINT! ALL INFORMATION IS KEPT STRICTLY CONFIDENTIAL!
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  11. (valid email required)
  13. Evacuation Plan: Where would you evacuate to? (We would like to stay in touch!)
  17. Emergency Info: In case of emergency, who should be contacted?
  22. QUESTIONNAIRE: PLEASE CHECK ALL THAT APPLY !
  23. Availability: Would your church be interested in assisting with response or relief in an incident?
  26. Interests & Experience: Check types of ministries that interests you. If your congregation has experience in any areas in addition to yourself, please note that experience in the box BELOW labled "Other". Thank you and God Bless You!!
  38. PLEASE NOTE: Your initials and signature below serve as authorization for us to process your request, acknowledgements, and acceptance; and, acknowledges that you are authorized by your church or ministry's Board and/or governing body to enter into this affiliation.
  39. AFFILIATION REQUEST: Our church requests to become an “affiliate member of the PRC Compassion network.” We understand that this affiliation in no way dissolves or preempts any denominational or other association commitments we have, presently or in the future. We also understand that one aspect of affiliation (by state definition) includes some level of support to PRC Compassion.
  40. PLEASE INITIAL AND SIGN BELOW IN SPACE PROVIDED.
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