Report Date *

MM

DD

YYYY

Change of Address

Yes

No

Local Church Telephone *

(###)

###

####

President Name

First Name

Last Name

President Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

President Home Telephone

(###)

###

####

President Work Telephone

(###)

###

####

Secretary Name *

First Name

Last Name

Secretary Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Secretary Home Phone

(###)

###

####

Secretary Work Phone

(###)

###

####

Prayer Ministry (10 Points) *

Yes

No

Literature Translation (10 Points)

Yes

No

Outreach/Servant Evangelism (10 Points)

Yes

No

Spiritual Growth Emphasis (10 Points)

Yes

No

Covenant Sisters (10 Points)

Yes

No

Bible Study (10 Points) *

Yes

No

Discipleship Training (10 Points) *

Yes

No

Benevolence (10 Points)

Yes

No

WMAM Missions Project (10 Points) *

Yes

No

Widow's Center (10 Points) *

Yes

No