Member Information Form

Peer Learning Group - Member Information Form

Convener's Name(*)
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Member Name(*)
Please let us know your name.

Member Street Address(*)
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Member City(*)
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Member State(*)
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Member Zip(*)
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Preferred Phone(*)
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Preferred Phone Number(*)
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Alternate Phone
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Alternate Phone Number
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Member Email(*)
Please let us know your email address.

Date of Birth(*)
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Male/Female(*)
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Name of College
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College Degree
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Name of Seminary
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Seminary Degree
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Other Degrees
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For Clergy:
Church where you currently work:
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Current Job Title:
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How long have you served with this congregation?
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How long have you been in ministry?
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Congregational size (average worship attendance)?
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Please describe the cultural context of your church using one of the following?
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For Laity:
Agency/Organization Where You Currently Work:
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Current Job Title:
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How long have you served with this agency/organization?
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Church Membership (Church Name, Location)
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How long have you been a member of this Church?
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List leadership positions you have held in your Church:
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For All:
How many of the following CBF meetings (please answer with a number in the dropdown) have you attended in the last four years:
National General Assembly
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Prayer Retreat
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State/Region General Assembly
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Church Works
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Other CBF event, workshop, or meetings attended (Please provide each event and the number of times attended):
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Please indicate which of the following leadership positions you have held in CBF:
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Does your congregation give to CBF?
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What are you hoping to receive from participating in this Peer Learning Group?(*)
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Any other comments, testimonies, suggestions?
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Information from this form will be entered into the database of the Cooperative Baptist Fellowship
If you have completed this form entirely, please click submit.

Questions? Please contact CBF Peer Learning Groups at plg@cbf.net

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