REGIONAL REPRESENTATIVE APPLICATION

Full Name*

Street*

City*

State*

Zip*

County*

Email*

Phone*

Member ID*

My Region*

My County*

Check ALL That Apply*

I am an AFFC member in good standing and would like to serve on the AFFC Board of Directors as a Regional Representative.

I understand that the Board of Directors' Regional Representative (BODRR) is chosen from each AFC/AFFC Region to represent and give a voice to the fire chaplains in my region.

As a Board of Directors’ Region Representative, I will help my region’s chaplains with their training, fellowship, and networking and help their fire departments find and set-up their own fire chaplaincy. I will lead, serve, and follow with humility, honor, and integrity.

Has your information on file changed?*

Yes

If yes, which has changed?

Address

Phone

Department

Church

Work

Other

Please include any information that needs to be changed here.

Thank you for applying to be an AFFC Regional Representative. We will reach out to you as soon as possible to finalize any other necessary details.

AFFC

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AFFC Mailing Addresses

AFFC President's Office

13351 Olivewood Road

Coker, AL 35452

AFFC Administration Office

6144 Harpers Diary Loop

Bessemer, AL 35022

Other Contacts

Terry Jacobs

tjacobs@alfirechaplains.org

(205) 792-4888

Wanda Manning

wmanning@alfirechaplains.org

(205) 447-2787

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Alabama Fellowship of Fire Chaplains Est. 2012

REGIONAL REPRESENTATIVE APPLICATION

Other Contacts

Alabama Fellowship of Fire Chaplains

Est. 2012