FLORIDA BAPTIST CONVENTION

Volunteer Chaplaincy

When you complete the Basic Application you will be entered into our database and become a part of the Florida Baptist Chaplains Network. You will also receive notice of all training and fellowship activities planned for chaplains and their spouses.

Name: Address:

City: State: Zip Code:

Email:

Phone: Cell: Date: 00 1 2 3 4 5 6 7 8 9 10 11 12 00 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 00 2007 2008 2002 2001 2000 1999 1998 1997 1996 1995 1994 1993 1992 1991 1990 1989 1988 1987 1986 1985 1984 1983 1982 1981 1980 1982 1981 1980 1979 1978 1977 1976 1975 1974 1973 1972 1971 1970 1969 1968 1967 1966 1965 1964 1963 1962 1961 1960 1959 1958 1957 1956 1955 1954 1953 1952 1951 1950 1949 1948 1947 1946 1945 1944 1943 1942 1941 1940 1939 1938 1937 1936 1935 1934 1933 1932 1931 1930 1929 1928 1927 1926 1925 1924 1923 1922 1921 1920 1919 1918 1917 1916 1915 1914 1913 1912 1911 1910 1909 1908 1907 1906 1905 1904 1903 1902 1901 1900

I am Blank Liscensed Ordained Layperson I am Blank Single Married Divorced Widowed My Birthday:

My Church Membership: City:

Date I was baptized: I am Southern Baptist: yes no

Have you served as a chaplain before? Blank yes no Where?

Church/Denominational Activities:

My highest level of education: Blank High School Vocational School College Seminary Post Graduate Studies I have special training in

Describe your personal encounter with Jesus Christ.

How do you share your faith?

Why do you want to be a volunteer chaplain?

Thank you for completing the Basic Application. Please forward a recent black and white photo to Marc Johnston, 1230 Hendricks Ave., Jacksonville, Fl 32207