Affiliation Form — Georgia North American Missions

Affiliation Application.

This form is for affiliating a church with the United Pentecostal Church International. You will need to submit a $5.00 fee with this application. Beginning July 1, 2025 the fee increases to $100.00.
Checks can be sent to the mailing address:

Georgia District UPC
P.O. Box 1550
Lithia Springs, GA 30122

Name of Church

ID #

Physical Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Choose either option 1 or option 2

Add the date the action was taken below.

At a business session of the church a resolution was passed to adopt the Articles of Faith and by-laws of the United Pentecostal Church International. We now desire to work in cooperation with them and be under their protection.

This church was established by a minister of the United Pentecostal Church International and was set in order by a member of the District Board.

Date Resolution Passed

or when church was established

YYYY

We have adopted the suggested form of Local Church Government as in the current issue of the Manual and as it shall be amended from time to time.

Yes

You will need to contact the District office to submit a $5.00 fee with this application.

If you did not adopt the suggested form of Local Church Government, you will need to submit a copy of your by-laws. This application must be endorsed by at least three officers of the church and by a majority of the District Board, including the District Superintendent.

Pastor

First Name

Last Name

Secretary

First Name

Last Name

Board Member

First Name

Last Name

Trustee

First Name

Last Name

Affiliation Application.

Georgia NAM