Institutional Membership Application Form

Organization Information

Institution / Organization Name:

Address

Street Address City State / Province / Region Country

Website:

Primary Contact Person:

Title / Role:

Email Address:

Phone Number:

Type of Institution

Academic / Theological Institution

Hospital / Health Care Facility

CPE Training Center

Faith-Based Organization

Nonprofit / NGO

Other

(please specify):

Membership Benefits

✅ Group access to GAPPC resources, training materials, and manuals

✅ Priority registration for conferences, certification programs, and webinars

✅ Recognition as an official GAPPC Institutional Partner on our website and publications

✅ Eligibility to participate in collaborative research, CPE partnerships, and international forums

Membership Commitment

Annual Institutional Membership Fee $350.00

Preferred Payment Method:

Check

Credit Card

Online Payment

Other

Authorized Representative Name:

Signature

Date

GAPPC Office Use Only

Date Received:

Approved By:

Membership ID Number:

Date Activated:

Total

Price:

Credit Card

Card Details

Cardholder Name

For Resources	20.00USD
Discount ()	-0.00USD

GLOBAL ASSOCIATION FOR PASTORAL PRACTICE & CLINICAL CHAPLAINCY (GAPPC)