LOC - Update Licensed Worker Personnel Info • Alliance NW

UPDATE or CHANGE FORM (Contact Information & Personal Status)

IMPORTANT: To help keep your contact information up to date, we kindly ask that all ANW licensed workers or church administrators use this form to inform our office of any personnel & personal changes. This will help ensure that your annual licenses are sent to the correct address and the national office database is up to date with your latest information.

Note: This form is made available to you to make personal changes all year round.

Thanks in advance for your help!

Reason for change *

Reason why you are no longer in a ministry role:

Other Reason:

New District you are a part of:

Start Date

End Date

First Name *

Last Name *

Gender *

Middle Name

Date of Birth *

Deceased Date

Email Address *

Mobile Number *

Home Address *

Home City *

Home Zip Code *

Home Address Line 2

Home State *

Home Country *

Is your home address the same as your mailing address? *

Yes

Mailing Address

Mailing City

Mailing Zip Code

Mailing Address Line 2

Mailing State

Mailing Country

Work Information

Church Name

Official Title

Retirement Date

Family Information

Please fill out your family information below.

Marital Status *

Divorce Date

Spouse Gender

Date of Marriage

Spouse Full Name

Spouse Birthdate

Do you have children? *

Please provide each child's name, birthdate, and gender.

Child 1 Name

Child 1 Birthdate

Child 1 Gender

Child 2 Name

Child 2 Birthdate

Child 2 Gender

Child 3 Name

Child 3 Birthdate

Child 3 Gender

Child 4 Name

Child 4 Birthdate

Child 4 Gender

Child 5 Name

Child 5 Birthdate

Child 5 Gender

Child 6 Name

Child 6 Birthdate

Child 6 Gender

Child 7 Name

Child 7 Birthdate

Child 7 Gender