Join D.I.M.A.

14380 Amargosa Road

Victorville, CA 92392

Phone: 760-951-8500 Fax: 760-962-9267

Complete Online

What Is Required?

Please complete this application in its entirety.

Complete the form below, submit, and you will be re-directed to D.I.M.A Membership Page where you’ll be able to make payment of $100.00 (annual membership/licensing fee.)

OR Mail it to Us

Download printable copy of your form HERE and Enclose check or money order made out to Destiny Christian Center for $100.00 (annual membership/licensing fee) and return to Destiny Christian Center, 14380 Amargosa Road, Victorville, CA 92392

D.I.M.A. APPLICATION FORM

CHURCH INFORMATION

Title

Select One

Name

First Name

Last Name

Ministry Name

What is the name of your ministry/church?

Ministry Telephone Number

(###)

###

####

Mailing Address

Mailing address of your ministry.

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Subject

Message

Date Of Church Anniversary

YYYY

Date of Pastor’s Appreciation Service

YYYY

Date Ministry Started

YYYY

Administrative Contact Person

(Title and Name)

Administrative Contact Person

(Phone and Email)

PERSONAL INFORMATION

Marital Status: (Circle One) Married Single Widowed Separated Divorced

Full Name of Spouse

First Name

Last Name

Pastor's Birthdate

YYYY

Spouse's Birthdate

YYYY

Wedding Anniversary

YYYY

Home Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Home Telephone Number

(###)

###

####

Mobile Number

(###)

###

####

Spouse Mobile Number

(###)

###

####

Names and Ages Of Your Children:

(Name and Age)

First Name

Last Name

Age

Child 2

First Name

Last Name

Age

Child 3

First Name

Last Name

Age

MINISTRY INFORMATION

Date of Salvation

YYYY

Where?

Have you been filled with the Holy Spirit with the evidence of speaking in tongues?

In which field of ministry do you feel you are called?

Explain

Are you a Licensed Minister?

Are You an Ordained Minister

What Minister or Ministry provided your most recent prayer covering?

Name

Address

Are you in agreement with the Statement Of Faith and Qualifications for Membership Church Covering and Connection/Covenant of DIMA?

Please include a brief testimony describing your call to ministry (Use a separate sheet if necessary)

If at any time I feel I can no longer agree with the attached statements and practices, I voluntary forfeit my membership and/or ministerial credentials received from DIMA.

Signature and Date.