Interim Report

ROSTER CHANGE AND DATA BASE INFORMATION
FOR THOSE IN A NEW CALL -- OR UPDATING PERSONNEL INFORMATION

NAME

Marital Status Spouse

PREVIOUS CHURCH & ADDRESS

NEW CHURCH & ADDRESS

SS NUMBER

PHONE

BIRTHDATE

START DATE

ORDINATION

INSTALLATION DATE

NEW HOME PHONE

ADDRESS

EMAIL
(If unknown, advise the synod office as soon as possible.)

I prefer to be contacted via: Church Office Address My Home Address

DEPENDENTS:

name	relationship	birthdate

Other Information to Update Roster File:

NOTE: A rostered minister from a synod other than NTNL must notify his/her bishop immediately and request in writing a transfer to the roster of the NTNL Synod.