EMS
 Reaching the Hearts of Men for Christ through Every Man Shares in Evangelism, Mission and Spiritual Life

You may wish to print the following form and send it to us along with your $30 payment:

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_____  I am attaching a check in the amount of $30.00

_____ Please bill my credit card:    

    ______ Visa    ______ Mastercard           Card Number:_______-_______-______-_______
Expiration Date:_______/________           Signature_________________________________

Please make any corrections on the address line below:

Name: ______________________________________________________

Address: ____________________________________________________

City: _____________________________ St ______ Zip ______________

email:_______________________________________________________

Daytime telephone (_____) _____________   Evening Telephone (_____)_____________

Please fill in your current church information:

Church ID __________________

Church Name _______________________________________________

Address ____________________________________________________

City __________________________________ St ______ Zip _________

Conference _______________________________________

District ___________________________________________

EMS members receive our magazine, a devotional book and specialty items.  If you do NOT want to receive any or all of these please check:       q  Magazine          q Book               q  Specialty Item