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Membership Application

If you would like to be member of NIPA, complete and submit the form below, or you may download a PDF of the application to print out and mail or fax in. Mail to:

Network of Independent Pastors Association
c/o Tim Harrell Global Ministries, Inc.
707 South Military Hwy, Suite D
Virginia Beach, VA 23464

Office 757-424-2268
Fax 757-424-0113

All fields are required. Please fill out the form completely before submission.

Personal Information

Title Name (Last, First)

Spouse Name

Date of Birth Anniversary Date

Address

City

State Zip

Home Phone Work Phone

Home Fax Mobile Phone

Church Information

Church Name

Church Address

City State Zip

Church Phone Office Phone

Fax Assistant

Website Date Established

Ministry Type Approx. # of Members

Personal Reference 1

Title Name (Last, First)

Address

City State Zip

Phone Relationship

Personal Reference 2

Title Name (Last,First)

Address

City State Zip

Phone Relationship

Upcoming Events

Next Level Leadership Conference 2010

September 24-25, 2010

The Hampton Roads Convention Center,
1610 Coliseum Drive,
Hampton, VA 23666

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