4410 Box Canyon Drive
Temple, TX 76502-3263
NON MEMBER DISASTER
RESPONSE ID CARD RENEWAL APPLICATION
Print clearly or type your information! Please take your time and read everything on this application carefully. ID Card will be sent to the address you list below, please make sure you list the address where you want your ID Card sent
must be mailed.
Cannot be sent by e-mail or fax.
This application must be printed in Landscape format. Please type or print clearly
Name: ___________________________________________________ Date: ______________________
City: ___________________________________ State: ______________ Zip Code: ________________
Home Phone (____) ________________________ Business Phone (___)_________________________
E-mail Address: ______________________________________________________________________
ID Card EXPIRFES ON: _______________________________________________________________
In Case of an emergency notify: __________________________________________________________
Relationship ___________________________________ Phone: _______________________________
PLEASE READ EVERYTHING ON THIS APPLICATION FOR CERTIFICATION CAREFULLY
Please Read Carefully: Make sure you read this application for ID Card renewal very carefully before signing. No application will be considered or processed without this application being completely filled out, signed and dated.
RENEWAL FEE FOR PROCESSING DISASTER RESPONSE CLIP ON ID CARD $50.00: New ID card may take up to 2 to 3 weeks for processing and delivery once application has been received and approved. Your will receive the following.
1. Clip on disaster chaplain Mag strip ID Card
Checks or Money Orders: All donations must be in US funds. Make payable to: Chaplain Fellowship Ministries, Mail your completed application with your check or money order to the address at the of this page. Checks must clear our bank before ID Card will be shipped.
Major Credit Cards: You can make your donation using your major credit card by clicking on the donation button below. There will be a $3.00 credit card processing fee added to the total amount. Mail your completed application to the address at the top of this page after you make your donation. Application must be sent in for processing within 30 Days from the date your donation was made through PayPal.
I hereby certify that all the information on this renewal application is true.
Signature Is Required: ______________________________________________________ (Required)
FOR OFFICIAL OFFICE USE ONLY
Date Renewal was received: _________________
Date Renewal was reviewed: _________________
Renewal Approved by: _________________________________
Date Approved: _______________________________
Date Disapproved: ____________________________
Member's ID No: ______________________________
Chaplain Fellowship Ministries is a faith based Christian Ministry legally incorporated as a Nonprofit public charity with Chaplains and Ministers serving Nationwide. The information required within this application shall be subject to change without notice. Chaplain Fellowship Ministries reserves the right to refuse the renewal of any applicant or member by directive of the board of directors of Chaplain Fellowship Ministries. All decisions made by the board of directors shall be binding and final.