This compliance
must be signed by the Chief Executive Officer. Please sign in blue ink and return
with contribution payable to Michael Guerra: Treas. Regional Records Office:
6772 Palmetto
Circle South: Suite 205: Boca Raton, Florida 33433
I ______________________________,
Title:______________________(please circle one of the following):
a. corporation:
company: Academy: Seminary: Christian Counsel Center:
Bible Institute: Other: ___________________
Policy: No person on the
basis of race, color, creed, national origin, age, sex, handicap, or martial status, shall be subjected to discrimination
in Ecclesiastical training programs. This institute will comply with all
state and federal laws and regulations concerning nondiscrimination.
Organization Name: _________________________________________________________
Type Of Organization: _______________________________________________________
Federal Tax I.D. #: __________________________________________________________
Charities Reg: #: (for Faith Based Organizations): _____________________________
Incorporation Date: _______________State Incorporated: ___________________ Incorporated: Yes____No______
All
checks/M.O. must clear through treasurer : payable to: Michael J. Guerra: Treas: Bottom left of check: Print for C.C.E. annual Accreditation: Return to Regional Records Office:
With contribution to Compliance Status Plan of your choice. |
Address: ___________________________________________________________________
Contact Person: (please print clearly) _________________________________________
Title: _______________________________________________________________________
Tel: #: include area code: __________________________________
Cell Phone:___________________
Fax #: include area code: _____________________________________________________
E-mail: (if any) ______________________________________________________________
Check One: for profit ________ not-for-profit ________ public _________